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Author Topic: State Laws Are Contributing to the Spread of HIV and AIDS  (Read 21542 times)

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Offline AustinWesley

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    • HIV Discussion Group on Myspace!
State Laws Are Contributing to the Spread of HIV and AIDS
« on: October 10, 2007, 12:34:16 PM »
During discussion of another thread I had wondered what ever happened to the CDC recommendations that all persons between the age of 13 and 64 be routinely checked for HIV.    No one seemed to know so I decided to figure out what the problem was and why this hadn't been fully implemented by now.  As fate would have it a new article came out today which explains yet another bureaucratic mess in our country.

Here are the original guidelines which seem pretty thorough and intelligent.   I didn't print the guidelines because they are lengthy and it would have distracted from my whole point, but here they are for reference:

http://www.guideline.gov/summary/summary.aspx?doc_id=9799&nbr=5246&ss=6&xl=999

Now, the problem:

30-plus states bar routine HIV testing
Last Update: 10/09 10:34 pm 

Print Story | Email Story     

AIDS test (file) (2006 Getty Images)

ATLANTA (AP) - A new study says more than 30 states have laws that bar doctors from heeding a call by federal health officials to routinely test patients for the AIDS virus.

The Centers for Disease Control and Prevention announced new testing guidelines last year. It recommends all teens and adults under age 65 be tested for HIV when they visit doctor's offices, emergency rooms and other health care centers.

CDC officials say the guidelines are intended to make testing simpler by sparing primary care doctors from having to counsel patients before the test and getting patients' consent for it.

But the study released today in the online journal PloS One, finds that 33 states require informed consent for HIV tests, while 24 require disclosure of information about the testing and disease -- either in pretest counseling or in a consent process. It found only two states -- Rhode Island and Illinois -- took action to comply with the CDC recommendations.
 
http://www.keyetv.com/news/national/story.aspx?content_id=7ecd5c18-a254-4468-9018-ad0e39653425


I find it outrageous that people are not being screened for HIV and going untreated and undiagnosed for some bullshit "counseling" guidelines implemented by ass backwards and antiquated ideas.

Any standard consent form should allow physicians to test for HIV.   Physicians are not required to go through rings and hoops to diagnose patients with cancer, multiple sclerosis, or any number of other diseases to my knowledge.   This sounds like some fucked up result of do good-er idiots or the ACLU to me.   I'm angry now that I got my answer as to what's going on.

So, we got 33 states contributing to the spread of HIV and AIDS now? 

What's everyone think about this mess?

Wesley
 
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline HealthyMomma

  • Member
  • Posts: 128
Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #1 on: October 10, 2007, 12:53:14 PM »
Wow...I totally agree with you Wesley! Actually I am quite annoyed by this....  >:(

Offline David_CA

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  • Posts: 3,246
  • Joined: March 2006
Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #2 on: October 10, 2007, 01:37:50 PM »
I think a lot of it has to do with the stigma and the fact that there are few confidential tests available.  The only ones I know of, in our area, are the $60 ones that you Fed. Ex. and get the results via code over the phone in three days.  Getting a positive result from an HIV test is a traumatic enough experience without dealing with a lot else with it.  I know I found my status with one of those tests.  I wanted to hear it at home, in private, with my hubby there.  I know there are problems with this, too, as some people benefit from counseling.  That's why confidential tests should be available as an option to those who want them: let me deal with it at my pace as I'm ready.  If I were newly infected, I might not want to get my HIV+ result from a general Dr. that happened to be ultra-conservative and judgmental of being gay, etc.  Let people test in a situation where they feel comfortable and perhaps they'll be more likely to test.


David
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline koksi

  • Member
  • Posts: 82
Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #3 on: October 10, 2007, 03:40:39 PM »
I strongly disagree.  In a context where people are not guaranteed healthcare and access to HIV medication, it is important that people understand the ramifications of their test result and so I think states that require special consent are right to do so.  This is true for many illnesses but seems especially true for HIV:  people with a positive test result will face serious difficulties acquiring healthcare.  IF the government agreed to guarantee treatment to people with HIV, then I think streamlined testing makes sense.  But in the present climate of private healthcare, where insurers are desperate to find ways to exclude people from coverage, I worry that HIV tests without consent would contribute to discrimination against people with HIV.  Remember also that the federal government is tying Ryan White funding to 'names reporting' of positive test results to the CDC.  So with quick testing and names reporting, we are talking about the government potentially building a list of all the HIV positive people in the US.

Does written consent °really° discourage people from getting a test done?  Or are you suggesting that doctors test patients °without° even telling the patient that they are conducting the test?  The later seems to me to be a very troubling proposition.  So if the doctor is going to tell the patient anyway, does getting written consent °really° result in fewer HIV tests?  I would actually be curious to know.

seroconversion in March of 2006
positive test May 2006

10/2013: Undetectable, CD4 1000
2009:  Began Atripla

10/2007:  VL 2,300 // no CD4 numbers! :-(
09/2007:  Begin Truvada/Reyataz/Norvir
08/2007:  VL 824,000 // CD4 344 // 21%
06/2007:  VL 326,000 // CD4 351 // 17%
04/2007:  VL 410,000 // CD4 242 // 26%
06/2006:  VL 444,893 // CD4 479 // 21%
05/2006:  VL >500K    // CD4 402 // 17%

Offline edfu

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #4 on: October 10, 2007, 05:59:33 PM »
I really don't want to be inflammatory, but this issue really must be stated:  Mandatory testing without having the resources for guaranteed follow-up and medical care is extremely dangerous.  Testing without treatment is immoral.  What good does it do to tell people they have HIV if they can't access treatment?
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #5 on: October 10, 2007, 06:04:02 PM »
My point is that people are being misdiagnosed and going undiagnosed.   No matter how you want to deal with all the paranoia about the stigma and the trauma it really isn't the point I'm trying to address.   I think people are intelligent enough to understand they will need to seek out appropriate treatement.   

Because of this system people are going untreated and undiagnosed and some are dying.

Now, tell me a cancer diagnosis or Parkinson's disease or any number of other diseases aren't "Traumatic"?   This type of thinking is what I see a tunnel vision and I think it's important to address the bigger picture.

I've worked in a health care industry for 10 years.   I can assure you that those medical records all of you think are so private are not.   It's simply a myth.   

Yeah, I agree that insurance companies are a problem and HIV is just one of many exclusions, but if you lie about your status they'll eventually catch it anyway and have an out so to me it's a moot point.   I hate insurance companies and I know just how corrupt they are.   Don't think I'm about to defend them.

However, do all of you really feel that we should segregate out a section of the population for specific guidelines like this?   You've got to be kidding me.   I guess protecting privacy outweighs saving a life?

I strongly disagree.    If the actual number of HIV infected individuals was known in this country I think we'd have a better shot at getting better programs and improving existing ones.   

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline pozniceguy

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  • Posts: 1,181
  • Niceguy Dallas
Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #6 on: October 10, 2007, 06:08:47 PM »
there are many places ( states, cities, community centers etc, ) that conduct  anonymous testing. Here in Texas  ( Dallas) it is an easy thing to do and it is totally confidential.....you have to use your code number to get the results  and if  +tive they will provide counseling which consists mostly of how to get the attention and medications you may need..
I don't subscribe to the "Govt  collecting data on HIVers " conspiracy since they already collect so much about you anyway.....try getting some of that info.....If you have any insurance, private or public they already know you are +tive, if you get medicine from any pharmacy  local or by mail they certainly know your status, when any Dr treats you for HIV virtually all states have a reporting requirement just as they do for most infectious diseases......
In total I am not surprised that the CDC recommendations are not universally followed...This has always been treated as a "State" problem......and as the various pressure groups ( Ryan White etc...) gained influence the Federal govt became involved and chose to push the control and financing to the state level.....can't have it both ways.. ..

Nick
remember the good times...honor the past but don't live there
Le stelle la notte sono grandie luminose, nel cuore profondo del Texas

Offline BT65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #7 on: October 10, 2007, 07:03:25 PM »
I agree that a test shouldn't be given unless proper treatment can be offered.  And I know that a lot of people don't get treatment for one reason or another.  If treatment can be guaranteed to be offered regardless of someone's financial means (and I mean that the right kind of treatment i.e. labs, medications, physicals etc.) then o.k.  But if not, then don't intrude on someone's business when it comes to such a delicate nature.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline Miss Philicia

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #8 on: October 10, 2007, 07:09:30 PM »
I really don't want to be inflammatory, but this issue really must be stated:  Mandatory testing without having the resources for guaranteed follow-up and medical care is extremely dangerous.  Testing without treatment is immoral.  What good does it do to tell people they have HIV if they can't access treatment?

Agreed.
"I’ve slept with enough men to know that I’m not gay"

Offline JamieD

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  • Posts: 259
Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #9 on: October 10, 2007, 08:08:34 PM »
Is there something wrong with doctors being required to counsel a person before taking an HIV test? The CDC also recommended that positive results should be given along with cholesterol levels, and other such tests.  ??? Ummmm.... yeah, something like that. I am glad these states require informed consent before such tests. People should make informed decisions, and the CDC is basically trying to take the ability to make an informed decision away. I understand this is a public health crisis, but people need to know what they are getting themselves into.


I especially take issue with the idea that pretest counseling isn't necessary.

Offline RapidRod

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  • Posts: 15,288
Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #10 on: October 10, 2007, 09:21:23 PM »
The new guidelines was not for mandatory testing. The testing was to be offered to anyone that came in to a health care facillity, between those ages. No one was going to be forced to take an HIV test.

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #11 on: October 10, 2007, 09:28:17 PM »
Is there something wrong with doctors being required to counsel a person before taking an HIV test? The CDC also recommended that positive results should be given along with cholesterol levels, and other such tests.  ??? Ummmm.... yeah, something like that. I am glad these states require informed consent before such tests. People should make informed decisions, and the CDC is basically trying to take the ability to make an informed decision away. I understand this is a public health crisis, but people need to know what they are getting themselves into.


I especially take issue with the idea that pretest counseling isn't necessary.

Look, I have nothing against counseling, but yes I think this is paramount to discrimination.   Am I the only one who sees there are other diseases and viruses out there which require no "counseling"?   

Seriously, I've read response after response all seemingly ignoring the fact that NO other disease or diagnosis require a battery of counseling or plethora of paperwork to get to the TRUTH?

I'm sorry I don't live in Denial Land and think that it's better people have the FACTS then die off because of some perceived issues.   

How many people do all of you feel are acceptable DEATHS before we start tossing aside our self serving and selfish ideals are acceptable?

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline RapidRod

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #12 on: October 10, 2007, 09:43:11 PM »
JamieD, under the new guidelines, the person would be asked if they want to be tested. It would just no longer take a written consent to be tested, a verbal consent would surfice.

Here is the new guidelines. Everyone is making a mountian out of a mole hill. http://www.cdc.gov/mmwR/preview/mmwrhtml/rr5514a1.htm

Offline JamieD

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #13 on: October 10, 2007, 09:43:49 PM »
Do you think finding out you have HIV is just like finding out you have high cholesterol? How many other diseases carry such a stigma attached to them? Do people not want to date you or marry you or have sex with you when they find out you're diabetic? Do people with MS have difficulty telling their family that they have MS because they are afraid that their families might not let them eat off their plates anymore?
It is everyone's personal choice whether or not they want to know. And if you get infected from someone who didn't know their status, then take some personal responsibility and realise you should have used a condom until you knew they were free from HIV.

Offline RapidRod

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #14 on: October 10, 2007, 09:51:06 PM »
Quote
Posted by: JamieD 
Do you think finding out you have HIV is just like finding out you have high cholesterol? How many other diseases carry such a stigma attached to them? Do people not want to date you or marry you or have sex with you when they find out you're diabetic? Do people with MS have difficulty telling their family that they have MS because they are afraid that their families might not let them eat off their plates anymore?
It is everyone's personal choice whether or not they want to know. And if you get infected from someone who didn't know their status, then take some personal responsibility and realise you should have used a condom until you knew they were free from HIV.
Don't even try that kind of reasoning. No one was being forced to test, it ones option to test, but the health care facillities have to offer it to you if you fall within that age bracket. No one is being forced to do anything. Have you even read the guidelines?

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #15 on: October 10, 2007, 10:13:49 PM »
Don't even try that kind of reasoning. No one was being forced to test, it ones option to test, but the health care facilities have to offer it to you if you fall within that age bracket. No one is being forced to do anything. Have you even read the guidelines?

I would like to thank Rod for bringing back a sense of rational to the subject at hand.   Comparing cholesterol and HIV is ludicrous to me and I don't think this is even an adult argument to the situation at hand.

I've read all the guidelines and I've posted this as a group topic in my own group on Myspace and I was rather impressed by the response of a young gal who has indicated her thoughts on the topic so articulately.

Boy, I am starting to feel like the one admitted leper in the colony here.   Let's try to refrain from attacking each other and I have a challenge for those out there who have actually bothered to read the guidelines and additional commentary.   Please read it and absorb it prior to responding out of your own fear or what you may think of me personally.

I think this a very serious issue and it amazes me at the dramatic and negative responses I've read thus far.   

I personally think the CDC guidelines will help save thousands if not millions of lives.   I'm not one to sit here and argue over petty issues and conspiracy theory topics in great length.   

The reality is that lives can be saved if people actually know there status.   I don't care if you love me or hate me, but surely you many of you are able to put aside personal issues to look at the bigger picture.

Not one person has addressed the issues I've brought up about the multiple other critical and life threatening illnesses which people are faced with aside from HIV and why they either feel all of those require "counseling" or special handling.  Why is that?

I think if we could bring this issue to the forefront in a sensible fashion without singling out certain people we might have a shot at making headway. 

Call me a dreamer, I hope I'm not the only one ; )


Wesley

PS.  Gotta love John Lennon!
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline Basquo

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #16 on: October 10, 2007, 10:19:21 PM »
Finding out you have HIV is not like finding out you have high cholesterol, I’m in total agreement with that, but if you have extremely abnormal test results, that means your doctor should counsel you before more tests are done, especially when those results could be indicative of a life-changing diagnosis.

Perhaps if doctors were to explain thoroughly all the tests that would be performed routinely, including HIV, then patients would be better prepared when they get that call saying “Your test for__________ came back with_________” then patients would be better prepared for the confirmation tests that would be ordered.

In a hospital setting, whenever we want to change the way caregivers perform, we talk about the “culture” of the healthcare setting.  If said culture included antibody tests in the doctors’ routine care, then maybe we could get antibody tests to be performed as accepted and expected as a regular part of checkups.

I remember going to see my new doctor in 1999, and telling him that I hadn’t really had a checkup in 10 years. He sent me off with a lab slip telling me that those were the routine tests for a man of my age and situation, and if there were any “out of range” results he would call me, whether blood sugar or CBC items or liver panel or a billion ketones.  I don’t see why if every doctor did this, HIV couldn’t be accepted as a regular test, but it’s trying to integrate the culture that clashes with the existing stigma.

But I will say that my doctor at that time, whom I still like and respect but don’t see for insurance reasons, also gave me my positive results over the phone on the Friday afternoon before Memorial Day, and ended the call with, “so that’s where we are now.”  I hated him for a few months. He was weird for awhile, and seemed uncomfortable, but he finally warmed up and acted normal. Plus he was kind enough to do the antibody test anonymously, so it wouldn’t go to my insurance, and then wrote off the charges when I tried to pay for the test.

Offline David_CA

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  • Joined: March 2006
Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #17 on: October 10, 2007, 10:27:42 PM »
Are we (as a culture, society, or whatever) willing and able financially to deal with all the new HIV+ people that will suddenly 'exist' and need some sort of help, whether counseling, financial assistance, etc?  I agree that testing should become more routine, but stopping the spread of this virus doesn't end with a test result; it only begins there.  I don't know what would or could stop the spread of HIV, but surely it'll have to be something medical, as in a vaccine or a 'cure'.   
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #18 on: October 10, 2007, 10:52:36 PM »
Are we (as a culture, society, or whatever) willing and able financially to deal with all the new HIV+ people that will suddenly 'exist' and need some sort of help, whether counseling, financial assistance, etc?  I agree that testing should become more routine, but stopping the spread of this virus doesn't end with a test result; it only begins there.  I don't know what would or could stop the spread of HIV, but surely it'll have to be something medical, as in a vaccine or a 'cure'.   

Heya David,

I really appreciate the thought and various opinions you bring to any topic whether I agree or don't.   You've a great knack for addressing all sides to a topic I think.

I'm not here to propose a cure or vaccine in this topic.

I'm merely bringing the subject upfront and hoping to learn.    I have yet to hear from one single person who has actually read the information and subsequent discussion about the idea that YES, as a matter of truth and fact everyone who happens to test HIV+ has a VALID RIGHT to know their status without being tossed into some emotional trash compactor as if they have NO mind of their own.  I find this concept to be not only demeaning, but rather patronizing in nature.  I've mentioned a variety of life threatening illnesses and conditions which require nothing like this.   I don't think all of us are such pathetic victims and quite frankly I a bit stunned by those who are so Hell bent on making sure we are all dragged down into the caverns of Hell with them.   Rubish!

I think people are a LOT tougher than we are giving them credit for.  Just for instance let's think about the HIV situation in the US.   Currently, 1.2 million are presently known to be living with the virus here.   There are some 6000 people represented here.   Are all of you so fragile and suicidal?

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline David_CA

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #19 on: October 10, 2007, 11:12:42 PM »
Ok, Wesley, I'll take the bait!   ;)  I'd demean or patronize any day to err on the side of caution.  Just as you think people should be able to learn their status as routine (your blood pressure is 120/73, your LDL is xxxx, your HIV antibody test is positive, etc), I think that it's just as important that people be able to receive what help they need following such a test.  This help can be in many forms, such as medical, counseling, education, etc.  All 6000+- members on this forum have some form of internet access and a pc available somewhere.  A lot of people don't. A friend of ours whose brother was homeless and a junkie (her term) didn't have this benefit.  He was assisted in some fashion after diagnosis, but certainly didn't have anything like 'net access and this forum.  If we're going to treat HIV like any other illness, we need to do so all the way.  That means no more stigma or discrimination.  I don't see how we can end either of these two things, but until we can, HIV will not be 'just another illness'.  And yes, I did read the link in your initial post!

David 
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline Basquo

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #20 on: October 10, 2007, 11:21:54 PM »
 I don't think all of us are such pathetic victims and quite frankly I a bit stunned by those who are so Hell bent on making sure we are all dragged down into the caverns of Hell with them.   

Who's this "us"? You got someone in your pocket? Meaning: who that replied to this thread gave you that impression?

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #21 on: October 11, 2007, 12:05:32 AM »
Austin,

I haven't read every word of every post here, but one thing stands out that some have made reference to but have not elaborated.

The Problem you point out here in your original post has not been lost on many of us in this work fulltime.  Yes, you are right, this is an abomination and goes exactly in the reverse of what is logical from our standpoint. 

That being said; the CDC makes guideline projections/recommendations all the time, but if it is not a mandate which is funded, there are few hospitals and private physicians who will comply.......UNLESS........ it is easy, cheap and doesn't cut into the bottom line of the practice or health care facility.  You see Wesley, unfortunately money, risk, increased work load, increased reporting, and on and on, are real and tangible issues that hospital boards as well as private doctors have to face daily.  More and more, doctors are going for the easy buck and while many of us know that HIV is far different today than when they were in medical school, this disease has been left on the infectious disease department, and those doctors are far and few between these days.  They are always in great demand, but seldom pay worth a shit, so they go to other specialities to bolster their incomes.

My hunch is that states have been hesitant to enforce these recommendations, as most of the time the responsiblity falls on the medical community without any compensation, but it then becomes an orphan child of the states, and in turn adds Millions of dollars to their health budgets, which are already bursting at the seams.

I am not saying here that these are the only reasons, but you did request that we bring all issues in this discussion to the table, so I just couldn't help myself.  Sorry, I am a Capricorn.

Love,
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #22 on: October 11, 2007, 02:34:46 AM »
Ok, Wesley, I'll take the bait!   ;)  I'd demean or patronize any day to err on the side of caution.  Just as you think people should be able to learn their status as routine (your blood pressure is 120/73, your LDL is xxxx, your HIV antibody test is positive, etc), I think that it's just as important that people be able to receive what help they need following such a test.  This help can be in many forms, such as medical, counseling, education, etc.  All 6000+- members on this forum have some form of internet access and a pc available somewhere.  A lot of people don't. A friend of ours whose brother was homeless and a junkie (her term) didn't have this benefit.  He was assisted in some fashion after diagnosis, but certainly didn't have anything like 'net access and this forum.  If we're going to treat HIV like any other illness, we need to do so all the way.  That means no more stigma or discrimination.  I don't see how we can end either of these two things, but until we can, HIV will not be 'just another illness'.  And yes, I did read the link in your initial post!

David 

David,   I think one thing you and I and most everyone can agree upon is that an HIV diag. is initially devastating.   My point which apparently I shall have to REHASH over an over again it that putting things into perspective HIV is NOT the worst illness or disease in this county.  Certainly, by personal experiences from friends and family I've dealt with a vast array of debilitating and horrific issues that range from cancer to Alzheimer's and others. 

I have rehashed the question over and over again, but NOT one person seems to feel all of these other people faced with tragic and traumatic diagnoses needs all the RED TAPE BULLSHIT counseling and special "protection" by law.   Am I just crazy or is this just a tad hypocritical?

Personally, I don't believe that the CDC guidelines will make some "utopia" society for all of us, but I don't think it will hurt.  We've all been either living in a closet intentionally for the last 25 years and look where it's gotten us?   People are so scared and in some instances rightfully so.   I ask (not just you)  do people think this is helping the cause?   

It's all so ironic to me.  I fight with my own parents who are conservative Republicans.   Ugh, I may be sick now ; )   HELL, both of them are in their 70's and now seem to realize the tragic situation in our country for people with HIV and other illnesses.   Despite their prior attitudes which apparently existed inside some box I've managed to break though to reality with them overall.   It wasn't easy and I put out the effort and made a difference.     Yeah, I still want to puke when my dad listens to Rush Limbaugh and I keep on fighting with my own family.

I wish I could be like some of these other people and just not care, but it's not in my nature.  I don't think I can personally change the world, but I'll be damned if I'm just gona go along with the "politically correct" losers who apparently are part of the pod people who have no ability to think for themselves or even make the slightest attempt at improving things for others.   

David, I like you.  None of my rambling commentary is directed at you personally.   I do however wonder how others can live with their own apathy and sit around doing nothing?

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline BT65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #23 on: October 11, 2007, 06:18:21 AM »
OK, if the doctor (or nurse) asks someone if they want to be tested, and that person says yes, has an HIV antibody test run and it comes back positive, then the hospital should be able to deal with everything the person who got tested wants, i.e. "what kind of treatment can I get, I don't have any money," "where can I find a good doctor," "what do I do now."   So if they want that, then they should invest on schooling their workers on all the counseling techniques/referral sources etc. that would go along with it. 
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline RapidRod

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #24 on: October 11, 2007, 07:11:50 AM »
Betty, at Ohio State Medicial Center, they did everything for me. They set up my ADAP, they filed for my SSI and sent the paperwork to Jobs and Family Services for medicaid. I guess it depends on where you go, how much help you get.

Offline bocker3

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #25 on: October 11, 2007, 07:54:18 AM »
A very interesting post here!  I have a few thoughts.

1. While I do agree that support and treatment SHOULD be available to all who get a positive test, I do NOT think that the lack of such support means people shouldn't know their status.  Denial does not make the virus less dangerous or less able to be passed on.

2.  The issue of whether people should have counseling before a test is a difficult one and arguments can be made on either side.  Counseling after a positive test is, I hope, a no-brainer.

3.  Now, to the heart of the thread -- do the state laws contribute to the spread??  I'm not totally convinced.  All the law does is require a discussion and SIGNED consent vs. verbal consent to take a test.  So every doctor in every state can follow the guidelines by OFFERING the test.  Do they?  Probably some do and some don't.  The real problem is likely to be that many, many DO NOT WANT TO BE TESTED.  It can be offered every day, but if the patient says, "no", then it makes no difference.  How many here avoided being tested for a period of time?  I know that I did.

So, I think that offering the test is the real key here.  The difference between signed vs. verbal consent is not a huge difference.  I think that many of the laws were put on the books to insure that no one was tested without their consent.  I know that many people go to their doctor and then go to the lab without knowing what they are being tested for or why.  This is not a good thing, but it is reality.  The written consent laws address this concern.

Thanks for the topic Austin!

Mike

(edited for typos)
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #26 on: October 11, 2007, 09:30:59 AM »

I find it outrageous that people are not being screened for HIV and going untreated and undiagnosed for some bullshit "counseling" guidelines implemented by ass backwards and antiquated ideas.


I find it sad that in this day and age there is an antiquated (and terribly off the mark)  argument against mental health counseling for HIV testing and diagnosis. 

Austin - your entire argument based off your subject line is flawed because of this particular point.  It is not people not knowing their status that is the cause of the spread of the virus sexually - it is people not using condoms that is the cause of the virus being spread sexually.

I'm certain you must realize that someone getting a diagnosis of being neg today is not conclusive of whether of not they are neg at the time of the test results and has nothing to do with their status at the time of the test results if they engaged in any risky behaviour since testing.

I do hope you are able to comprehend and appreciate that vital point.

I assume you are able to, so now I ask:  what good is having a neg result do for those who continue to not use condoms? 

See that is the real issue. 

We continue to see on this board how many people become embolden to continue having unsafe sex simply because they got a neg result...and yet as we all know a neg result doesn't necessarily mean one is neg, now does it? 

So to your statement that State Laws are contributing to the Spread of AIDS because of counseling requirements - I ask:

Would you not agree that implicit in telling people that they have a neg result is counseling them and educating them on what the result means and what it doesn't mean and how to avoid risking themselves or others? 

Frankly it comes down to one simple point (in relation to your argument:)

Is the government's responsibility towards the welfare of their citizens only to tell them they are infected at the moment of the test results or is it to offer them understanding of what the test results mean and how they can avoid infecting others and themselves and to try to make certain that it's citizens do not infect each other whether through willful neglect of information or blind ignorance of what the information means?

Not only do I believe it is the latter, but frankly anything less that seems more akin to your argument that the state governments might be a contributing factor in the spread of HIV.






Offline sacinsc

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #27 on: October 11, 2007, 09:44:13 AM »
Wow, this thread got so long I had to stop reading. (ADHD) Anyway, I dont know if anyone brought this up. But what about if the test everyone as the CDC recommends and the person chooses to know or not. Just so that we have a more correct count in the country of the people with HIV so that maybe when we get a new President they will spend some money on this issue. This may give the counseling that we need so that more and more will know their status and get the treatment they need and help stop the spread of this damn virus. It may also trigger the administration to finaly force the drug companies to spend more money on finding a cure rather than spending money on keeping us alive with drugs that they make billions off of. Just a thought.

Matt
March 07 - Negative
May 07 - Exposed
June 07 - Seroconversion
September 07 - CD4 402 VL 118000 25%
October 07 -     CD4 294 VL 124000 22%
November 07 - Norvir, Triuvada and Reyataz
December 07 -  CD4 355 VL  550 .... guess the meds are working.
January 08 - CD4 446 VL <48 undetectable!
April 08 - CD4 554 VL <48 undetectable!
July 08 - CD4 666 VL <48 undetectable! Hporay...I have devil CD4's

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #28 on: October 11, 2007, 09:50:11 AM »
My point which apparently I shall have to REHASH over an over again it that putting things into perspective HIV is NOT the worst illness or disease in this county.  Certainly, by personal experiences from friends and family I've dealt with a vast array of debilitating and horrific issues that range from cancer to Alzheimer's and others. 

Something about this line, this point that you have indeed rehashed numerous times on here just sticks in my craw.  Something about having the seriousness is this illness dismissed time and again on its very own support site leaves me really cold.  I'd love to see printed here your ranking for which diseases really qualify to be listed among the worst.  I'm sure some others, like Christine perhaps, might like to see that as well.  Imagine her embarassment when she realizes she's been making such a fuss over nothing.

Are all of you so fragile and suicidal?

Not all, but some.  Trust me on this one.
AIDS isn't for sissies.

Offline koksi

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #29 on: October 11, 2007, 09:54:08 AM »
Concern regarding reporting of names is not necessarily conspiratorial.  You can't be known to have HIV if you never have a test.  But what is happening is a proposed simultaneous increase in testing plus mandatory surveillance.  I don't necessarily think it all amounts to a government plot that we should be super afraid of.  Nevertheless, it's worth being critical about these developments and considering them carefully, rather than yelling about the ACLU – a red herring if ever there was one.

The point is that a conjunction of factors could yield greater surveillance and diminished freedoms through HIV, because in the US people live in a climate where people are not guaranteed care and where transmission can be criminalized in complicated and non-obvious ways (cf. California court decisions on 'constructive' vs. 'active' knowledge of HIV status).

seroconversion in March of 2006
positive test May 2006

10/2013: Undetectable, CD4 1000
2009:  Began Atripla

10/2007:  VL 2,300 // no CD4 numbers! :-(
09/2007:  Begin Truvada/Reyataz/Norvir
08/2007:  VL 824,000 // CD4 344 // 21%
06/2007:  VL 326,000 // CD4 351 // 17%
04/2007:  VL 410,000 // CD4 242 // 26%
06/2006:  VL 444,893 // CD4 479 // 21%
05/2006:  VL >500K    // CD4 402 // 17%

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #30 on: October 11, 2007, 09:57:10 AM »
Did anyone understand anything I typed above, or am I becoming totally daft?

When discussing this issue, I see no way to separate the back story of funding from the obvious, but then I am probalbly wrong here.
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #31 on: October 11, 2007, 10:06:49 AM »
Tim,

I agree with your point and heard it loud and clear.

 I just think that the whole original premise that Austin began his argument with and based it off of was erroneous to begin with.

Offline Dachshund

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #32 on: October 11, 2007, 10:14:08 AM »
For every person that eventually starts treatment six more people become infected. Sorry but the system can't bear it. The majority of funds for counseling and treatment come from public funds and the reality is that those funds are finite. The reality is waiting lists and overburdened bureaucracy's. We can wax esoteric all we want, but the reality of a six to one ratio in dealing with treatment versus rate of infections just does not seem sustainable.

Iggy is spot on in his assessment, though I would like to throw needle exchange in with using condoms.

Offline David_CA

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #33 on: October 11, 2007, 10:28:32 AM »
Iggy is spot on in his assessment, though I would like to throw needle exchange in with using condoms.

I'm glad you brought that up and was meaning to add that to the previous post I made mentioning a friend's brother.  He was one that possibly would have benefited from such a program.  I think this almost makes more sense, in a way, than free condoms.  Condoms are available almost everywhere there's a store.  Needles and syringes aren't as easy to come by.

David
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #34 on: October 11, 2007, 10:46:16 AM »
Moffie, when I first read this thread, when there were no responses, I started to post something related to the funding but figured I would be seen as putting money before what needs to be done.  However you are totally right.

Testing everyone is simply not possible.  The strain on the medical system, as auntie said, is just not sustainable.  As an example I will offer my experience in finding a new doctor.  In Louisville there are very few drs that specialize in the treatment of HIV.  Recently my dr, one of said drs, closed his practice.  Sending several hundred patients on a new dr hunt.  When I had my first appointment with my dr, he said he was unsure how all of us would be able to find a new HIV dr, as he was being stretched with all the new cases..  We are fortunate and have insurance.  Imagine what will happen when 100's turn into thousands, many without insurance, find out they are HIV+.  

I agree everyone who is positive needs to know.  However just testing and telling someone they are HIV+ simply is not enough.  It gives the appearance (like so many other problems our government tries to fix) that something is being done to prevent the spread of HIV, but without medical treatment, including the opportunity for mental health treatment, what good does it do.  We must figure out how to take care of all the new cases that will exist before implementing a policy of universal testing.

BTW, spot on  Iggy.

Woods



edited for clarification
« Last Edit: October 11, 2007, 10:48:41 AM by woodshere »
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline mjmel

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #35 on: October 11, 2007, 10:55:25 AM »
Moffie wrote:
"Did anyone understand anything I typed above, or am I becoming totally daft?

When discussing this issue, I see no way to separate the back story of funding from the obvious, but then I am probalbly wrong here.
"

Oh my. That got me chuckling in a goodly fashion.
Just saying.........I understood, clearly.

Mike
« Last Edit: October 11, 2007, 11:01:27 AM by mjmel »

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #36 on: October 11, 2007, 11:18:39 AM »
Lots of interesting replies and ideas!   

Here's one reply from a gal in my group who's responded from a different perspective from someone who does HIV testing I found interesting:

"It is a mess. I work in the testing field in Pennsylvania. Not only is there a consent that needs signed, but a history form (which is completely different then the "regular" history form for general STD testing) and then on top of that there is a risk assessment form. By the time I actually see the patient they have been in the office for at least 30 minutes filling out papers. If I could just order the test for everyone that walks in the door - it would be so helpful for everyone. I feel that it would also release the stigma of going to get an HIV test - because now everyone gets one."


I happen to agree with her.   Surely, I'm not the only one who knows several people who ended up in the hospital sick from a whole variety of issues and didn't have a clue they were HIV+.

Had I not insisted on my own HIV test I'm not sure I would have ever known the truth because originally the symptoms I had from seroconversion were mistaken as a likely allergic reaction to a prescription drug I'd recently taken.

I've never tried to minimize the impact of HIV/AIDS.   I'm trying to put it into perspective.   I find it ironic that all of the other tragic illnesses out there don't require doctors and medical staff to go through reams of paperwork, red tape and counseling to get to a diagnosis.

I wonder how many people going misdiagnosed or undiagnosed are continuing to spread HIV unwittingly to their partners?   

I'm not saying the states are responsible, but it certainly seems to me that these stupid laws are contributing to the epidemic and even the stigma as I see it.   
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline jack

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #37 on: October 11, 2007, 11:39:26 AM »
isnt one of the main reasons mandatory testing for hiv is off limits because there was time when many feared this could be used against them? Even some feared all of us could be rounded up and sent off to Australia? I wish.
 The people who proposed this back in the day were attacked as being fascists and worse.

I do agree finding out  you are hiv pos is more traumatic than discovering you have high cholesterol but approx.450000 died from heart disease last year in US. the most recent figure I could find on HIV was 2005,and the deaths were around 17000 with a total of 500000 infected.

To not have mandatory testing is insanity.

Offline allopathicholistic

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #38 on: October 11, 2007, 11:54:33 AM »
If the actual number of HIV infected individuals was known in this country I think we'd have a better shot at getting better programs and improving existing ones.   

Good point, had to quote it

Offline David_CA

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #39 on: October 11, 2007, 12:16:26 PM »
As to the complexity and number of forms that need to be signed, I'll agree that the what the lady in Penn. deals with is a bit extreme to me.  I believe that when I had a confirmation test done after my mail-in test, I just signed the one for being tested for HIV (but I can't swear to this).  Doing it anonymously would / could eliminate lots of this BS and simplify things.  Simplification can be good, as in less overhead, which should mean less cost. 

I think a variety of testing options would be a good thing, though.  The lab in the second installment of Stephen Fry's show is a good example of a simple testing situation.  I can understand that once one needs medical or some sort of assistance things would get a bit more complex.  But to actually get large numbers of people to test, it has to be easy.  It has to be unintimidating.  It has to be private and discreet.  It has to be tailored to serve the people needing the testing.  People who go to a 15 minute testing center wouldn't have much in the way of counseling, but they'd be informed of that up front.  They'd be told that they can have the test done elsewhere that has resources (assuming such a place exists) to assist them.  In the event they test positive, they could be given information on where to go from there... in what steps they can take.  All of this goes back to downplaying the stigma of an HIV diagnosis instead of emphasizing it, as the myriad of forms mentioned in Wesley's example would do. 
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Offline StrongGuy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #40 on: October 11, 2007, 02:38:46 PM »
Quote
If the actual number of HIV infected individuals was known in this country I think we'd have a better shot at getting better programs and improving existing ones.   

Very good point.

Quote
My point which apparently I shall have to REHASH over an over again it that putting things into perspective HIV is NOT the worst illness or disease in this county.  Certainly, by personal experiences from friends and family I've dealt with a vast array of debilitating and horrific issues that range from cancer to Alzheimer's and others.

Something about this line, this point that you have indeed rehashed numerous times on here just sticks in my craw.  Something about having the seriousness is this illness dismissed time and again on its very own support site leaves me really cold.  I'd love to see printed here your ranking for which diseases really qualify to be listed among the worst.  I'm sure some others, like Christine perhaps, might like to see that as well.  Imagine her embarassment when she realizes she's been making such a fuss over nothing.


I don't see this as Wesley minimizing or dismissing HIV or advanced progression of the disease in any way. In terms of devestating effects, there are many many other afflictions that are equally tragic, life shattering, depending on varying stages of disease progression. I do see how it could be interpreted as such, as Thunter shared, though I don't seet it that way. I think he made a valid point.

Anyway my main point was my first statement.

Very interesting views and good food for tought. I have to say I go back and forth on this whole topic and haven't made upo my mind yet.

Peace!
Mikey :)
"Get your medical advice from Doctors or medical professionals who you trust and know your history."

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Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #41 on: October 11, 2007, 09:18:16 PM »
Hi all I am new to this group but I have been reading and I must say there is a LOT of reading to do.  I read  some post and nearly laughed and others I sat here in horror to think and see that people could really think in such ways.

Points that shocked me;

I read in one post ( don't ask me wich one there are to many to go back through.)  that people not knowing their HIV status is not the cause of the spred.  You have got to be joking!!!  you can not tell me that ignorance is not the problem. 
then some one suggest they get the test but choose not to get the results.   ????  What good does it do to have a wonderful number and thousands of people running around not knowing they are spreding HIV.  I am thinking that kind of defeats the pupose of testing all together.  It not about gathering numbers it's about people knowing if they have HIV or not.
Now about condoms being used or Not being used.  I think if more people knew they were HIV+ they would be using condoms.  Again ignorance is not the solution here.

Now on the subject of HIV counseling.  I really do know that pre testing counseling is all it is cracked up to be.  Post testing conversation are not such a bad idea when the person feels they are ready to talk about it.  Not every one is ready to be counseled as soon as they hear the news.  for some they need time to let it set in and develope the questions they need to ask.

Now as for the guidelines  as I understand this they are not Mandatory nor are they federal law that all people be tested for HIV  So why are people bickering about it  It's not even a point.

Should people be asked if they want to be tested.  Of course they should.  Should they be treated as if this test is any different than testing for Cancer or  Tay-Sachs Disease or MS  or Diabetes,  NO.  All of these can be fatal and all of them are life altering yet none of them require that people be counseled before or after testing.  Why because they are accepted as common illnesses for ALL people.  I agree with Wesley that required counseling for HIV testing is discrimination.  To offer counseling is one thing but to force it is very much another.  To offer medical assistance is the right thing to do.  To referr people to other sources is also the right thing to do.  WHEN they are ready for it.

Mikey

Offline bocker3

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #42 on: October 11, 2007, 09:49:33 PM »
If the actual number of HIV infected individuals was known in this country I think we'd have a better shot at getting better programs and improving existing ones.   

I think this is a very good point. 

Funding for care (of HIV or anything else) is a big issue, but am I actually seeing people advocate that folks should not find their status if they don't have the means for treatment?  Do we really need to solve funding first?  While that would be the PREFERRED way, it certainly isn't feasible, so should people wait until they are on death's door to find out their status?  I don't think that is what is being said here, but there have been a number of posts that could be interpreted that way.  Knowing has got to be better than not knowing -- even if treatment isn't available, some people might still be able to insure that they don't pass it on (yes, condoms should be used by neg or poz, but obviously this isn't happening).

Finally, I'll say it again -- doctor's always have the ability to offer an HIV test to a patient.  If they aren't doing so because of "paperwork" or "red tape" then they need to hand in their licenses.  If people refuse to have the test because of paperwork or red tape, then most probably would have found some other reason to avoid it anyway. 

Interestingly, none of my doctors ever asked me if I wanted a HIV test -- and I've had about 5 or 6 different primary care docs over the years. 

Mike
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Offline Basquo

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #43 on: October 11, 2007, 09:54:25 PM »
The unfortunate truth is that many people only get tested when they have a personal concern (like a risky experience) or they have physical symptoms (of illness.)  I’m not saying most, I’m saying many. And this applies to HIV, cancer, diabetes, etc.

After thinking about it for a day, I’m definitely for routine testing. As an (mostly) STD, HIV is stigmatized, but look at where we are with herpes and HPV these days.  Media and other exposure have made these mainstream, and we can access information that tells us “X number of Americans have __________.’  The same info is ours for the estimated X number of Americans with HIV, but HIV is still not considered mainstream.

Anyone, even rich white people, can get herpes or HPV.  It’s just accepted.  When will HIV be accepted the same way?

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #44 on: October 12, 2007, 11:59:37 AM »
Eloquently put Creighton!

I think you've expressed what I've been trying to say very well with your post!

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #45 on: October 12, 2007, 01:11:28 PM »
Testing is very important and would inform many who do not know.  But millions of Americans don't go to the doctor.  So are we going to have ER's and urgent treatment centers do the testing whenever someone comes in to their facility.  Testing alone will not solve the problem, it has to be done with better education, also a greater willingness on an individual to protect themselves.

Plus until we decide where the money will come from for all the new cases, I am not convinced mandatory testing is the best at the present time.

Woods



edited because i posted before being finished
« Last Edit: October 12, 2007, 01:21:17 PM by woodshere »
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline Basquo

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #46 on: October 12, 2007, 01:32:35 PM »
I just want to clarify that I'm talking about routine testing, not mandatory testing.  You go into the doctor's for a check up, you go into hospital to have a baby, you get tested. You go into the ER for a broken arm, they need to do an xray and treat your arm, not run a bunch of bloodwork.  Likewise, if you have more serious trauma, they run the tests needed to stabilize you right then, and then as you are recovering they maybe do more routine stuff.  This country is not ready for mandatory testing. 
« Last Edit: October 12, 2007, 01:34:39 PM by Basquo »

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #47 on: October 12, 2007, 01:37:03 PM »
Then if it is routine testing, can a person opt out?


edited to add:

Will routine testing be able to reach some of the highest risk groups?  I only ask because I fear that if routine testing begins the perception will be that now we are finally get a grasp on the number infected, when thousands still will not know their status because they don't go to the doctor.
« Last Edit: October 12, 2007, 01:43:20 PM by woodshere »
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #48 on: October 12, 2007, 01:49:41 PM »
Sure!   If one would rather live in denial and neglect their health they have every right to.   However, we all know people who didn't get diagnosed until they were extremely ill and that only adds to the enormity of health care costs in this country.   

Many of us (including myself) support the idea of Universal healthcare for all.   One way to help achieve this is with preventative medicine and early diagnosis whether it's HIV or any number of chronic illnesses.   

I think we all need to share in some responsibility rather than contributing to the over taxing on the system because of self neglect.

Look at all the other things which have now become routine.   Breast screening for women is one.  Prostate and colon cancer screenings for men.   I don't imagine those are necessarily enjoyable or comfortable events for anyone, but they save lives and money and increase awareness.   My dad for instance is one of those who had such a screening and sure enough he had cancerous polyps.   According to the doctor had he waited another 3 or 4 months the cancer would have metastasized and spread throughout his body.   That's when people get really ill and it drives up the health care costs for everyone with lengthy hospital stays and related expenses that could have all been avoided.

Again, routine testing is different from "mandatory" testing.

Wesley
« Last Edit: October 12, 2007, 01:55:03 PM by AustinWesley »
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
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Offline Dachshund

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #49 on: October 12, 2007, 01:54:35 PM »

Look at all the other things which have now become routine.   Breast screening for women is one.   Prostate and colon cancer screenings for me.   I don't imagine those are necessarily enjoyable or comfortable events for anyone, but they save lives and money and increase awareness.



Unfortunately these tests are routine only for those that are insured or those wealthy enough to afford them.

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #50 on: October 12, 2007, 02:09:43 PM »
Hey Dash,

That's not entirely true!   Google Free Breast Cancer screenings as an example, and you'll find a number of various sites and programs for those who qualify.   There are different eligibility requirements on a lot of em depending on what state you are in or what program you look into.

I'm definitely not thrilled with the patchwork of programs and people being left allowed to follow through the cracks either.   

Still, I don't think not knowing your HIV status is a good idea simply because the programs out there are flawed and underfunded.

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #51 on: October 12, 2007, 02:21:40 PM »
Unfortunately these tests are routine only for those that are insured or those wealthy enough to afford them.

Thank you.  

Those tests are encouraged by media and the medical field, but one doesn't have to do them. My mom, who's grandmother, mother, and all aunts had breast cancer, refused to have a mammogram for years. Cost wasn't the issue, fear was.  I dare say not much different than the fear many have concerning being tested for HIV. Don't get me wrong I know it is important to know your status. But how is encouraging routine testing any different from what we are doing now.


Still, I don't think not knowing your HIV status is a good idea simply because the programs out there are flawed and underfunded.

Wesley, I really get what you say and hope you understand that.  But what are we going to do with the influx of thousands and thousands of newly diagnosed cases, most of which will be with out insurance, on an HIV health care system that is already strained.  Yes it might help lower the infection rate, but we must be prepared for the problems associated with the outcome of routine testing.
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #52 on: October 12, 2007, 03:25:01 PM »
Last time I checked, Oraquick was $14.00 a pop, and only if you buy more than 400.  Any less and the price rises to about $19.00.

Now, if this is done in emergency rooms, the price would rise to about $140.00.

We can moralize about testing, counciling, treatment and any number of issues, but if you don't take care of the $$$$$$$$$$$$$$$$ first, nothing is going to happen. 

Since we are spending $2,000,000,000 (billion) a week in Iraq, there is little chance that the Federal government is going to fund such a plan, nor will the states who are doing everything possible to keep from having all their bridges fall down. 

I humbly offer that until tens of thousands show up in emergency rooms with full out PCP, then nothing will be done.   Haven't any of you read the history of this disease?  Under our dear Ronnie Raygun, 50,000Hemopheliacs and Gay people had to die before that son of a bitch even said the acronym AIDSor HIV in public!  Does anyone think the self described "War President" could give a shit about HIV/AIDS domesticallly????  Why have all his AIDS directors been Baptist Ministers?  GEEZ Austin, wake up please; reason has left the planet for the time being.

Let us please get real in this discussion.

Love,
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #53 on: October 12, 2007, 05:39:15 PM »
OMG  Are you people serious  I can't believe that you would suggest that until thousands of people show up in emergency rooms with full out PCP, then nothing will be done.  Are suggesting that we do nothing and just wait till thousands of people are dying because it cost to much to test them.  You can't possiblily think that the best way to handle this is to do nothing.  How will waiting till thousands of poeple flood ER's with full out PCP going to save money.

Yes there will be thousands of new cases. Millions in fact!!!  but does that mean that they should not know they have HIV.  I should think not.  Such thinking is simply absurd.   Ignorance is NOT the solution,  It IS the Cause  Ignorance is NOT bliss, It is DEATH  Death for those who don't know they have and Death for those who they will infect.

We may not have the money to treat every new case of HIV but why should lack of funds be an excuse for people not knowing thier status.  Does any one think that people not knowing thier HIV status is going to make thinks better or stop the spred.  If I were a man who could be left speachless I surely would be at this point.

I am astounded  that so many people with HIV would NOT support making HIV testing a standard test.  Had any of you known that the person you got HIV from had been positive would you have engaged in the activity that infected you.  If they had known they had HIV do you think they would have given it to you.   Knowing one's status is the first step in brining this to an end.   If one thousand or one million new cases are found then we will find the money to treat them when they need it.  Just because a thousand new people test Positive today it does not mean that they will need treatment tomorrow.  They could go many years before they need treatment.  However waiting till they are all on thier death beds will only add to the cost.
« Last Edit: October 12, 2007, 05:46:12 PM by mike in VT »
Mikey

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #54 on: October 12, 2007, 07:09:05 PM »
OMG  Are you people serious  I can't believe that you would suggest that until thousands of people show up in emergency rooms with full out PCP, then nothing will be done.  Are suggesting that we do nothing and just wait till thousands of people are dying because it cost to much to test them.  You can't possiblily think that the best way to handle this is to do nothing.  How will waiting till thousands of poeple flood ER's with full out PCP going to save money.



  However waiting till they are all on thier death beds will only add to the cost.

Mike,

First off, I am one of the few here who has brought up the $$$$$$$$$$$$$$ subject and that was because Austin stated that 30 some states refuse to act on the CDC "suggestion" that the states do universal testing.  I merely stated the obvious in this time of huge holes in most states budgets.

Now on to the rest of this statement.  I have been in HIV activism since 1979, and screaming for universal testing since the test was created in 1985.  How does that weigh in your admonition that I wake the fuck up and advocate universal testing????????????????????????  I have run two HIV/AIDS service and education organizations and have yet to see the goals we have advocated for almost 25 years now; be adopted by this sleepwalking nation.  My present service area is about 13,000 square miles, about half the size of Vermont and I only work the southeast corner of this vast state.  One of the AMG guests motored across this great state and saw the scattered population over miles and miles of countryside.  I would really like to have a tangeble suggestion to give to the next HIV/AIDS State Advisory Council how we can get our REPUBLICAN State Legislature to mandate and fund universal testing in all the corners of this very large state.  I would suggest you do your homework on some of the posters on this site before your fingers do the walking.

Now for the last point.  How do you ENFORCE universal testing, when I just came home from an AIDS Walk planning meeting for our second annual AIDS Walk in this southwest, mormon, cowboy hick town in southeast Arizona and I was admonished by two very astute and active HIV women who have jobs in our county to leave the condoms at home, because they have been warned that if any more kids get condoms from their stash that they will be fired.  One of these women has been an activist since she lived in New York City in the 1980's. 

You are so very well versed in the ENFORCEMENT OF THE CONCEPT OF UNIVERSAL TESTING, I anxiously await your learned advice on how I should proceed.

This is one of the reasons I have been so very quiet lately, because I always get myself in trouble with some new person on these boards who call me out, I get pissed and react, and then I get timed out.  I also await my warning from the moderators, so fire away Mike from Vermont.

Love,
« Last Edit: October 12, 2007, 07:10:47 PM by Moffie65 »
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #55 on: October 12, 2007, 07:37:39 PM »
Moffie

Perhaps you should read my post again and this time without putting your own words in it.

Perhaps this seemly habit of your of putting words in peoples mouths is what has gotten you these time out (is that what you called them). 

I don't recall saying any of the things you claim I have.  So I have no need to explain it. 

I stand by my opinion that if people knew they were HIV+ they would be better able to protect other.  I can't imagoine that anyone with a reasonable mind would not be able to see that.
Mikey

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #56 on: October 12, 2007, 07:41:06 PM »
I humbly kiss your very fine ass.

Love,
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline Basquo

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #57 on: October 12, 2007, 08:20:05 PM »
this sleepwalking nation. 

Moffie is one wise man.  This is the crux of this discussion.  I believe.

Offline Peter Staley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #58 on: October 12, 2007, 10:28:36 PM »
I humbly kiss your very fine ass.

Love,

Moffie -- you know better than this.  Consider yourself warned.  You're very close to another TO.

Peter

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #59 on: October 12, 2007, 11:14:10 PM »

Wesley, I really get what you say and hope you understand that.  But what are we going to do with the influx of thousands and thousands of newly diagnosed cases, most of which will be with out insurance, on an HIV health care system that is already strained.  Yes it might help lower the infection rate, but we must be prepared for the problems associated with the outcome of routine testing.

Well, I would hope that we would help them.    Even just knowing a status is beneficial to take other measures even until such time all could be treated.   

Frankly, I'm not even going to address the ridiculous other suggestions that we just wait until people rot and die.   It frightens me that some who claim to be such long time advocates have such apathy and beyond.   

I think I'm a pretty down to earth person and I don't even know how to address the idea that I'm from another planet or whatever that mess was.

I've dealt with non profit organizations and been very involved in certain organizations related to cancer and some with HIV.   I don't need to boast about my alleged credentials further, but I realize people can get burnt out, become apathetic and self serving, but to me this is just shocking!

I am not suggesting any one person here, but the people who do obviously care about their fellow men and women have saved the day for me and my wild ideas that we can make progress.

Peace,

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #60 on: October 12, 2007, 11:43:59 PM »
Frankly, I'm not even going to address the ridiculous other suggestions that we just wait until people rot and die.   It frightens me that some who claim to be such long time advocates have such apathy and beyond.   

I think I'm a pretty down to earth person and I don't even know how to address the idea that I'm from another planet or whatever that mess was.

I've dealt with non profit organizations and been very involved in certain organizations related to cancer and some with HIV.   I don't need to boast about my alleged credentials further, but I realize people can get burnt out, become apathetic and self serving, but to me this is just shocking!


Don't know how to address posts others have made in this thread, you say?  Sure you do...with the same old back-handed & passive aggressive jibes you've always used.  Comments about being burnt out, apathetic and self-serving...things like that.  I don't believe background was provided to "boast" as you say about "alleged credentials", but to provide a frame for context.

Jesus H. Particular Christ!  Did any of you even READ what was posted above?  Hello?! 

Whatever else might be said of the poster to which you refer, one claim that CANNOT be leveled is that this poster is apathetic.  And at no point was the it suggested that waiting for people to rot and die was the correct course of action- just the one that was most likely to take place.  And I'm sorry, but history backs that position up.  And to this person's credit, it was also not said that you (Austin) were from another planet-  it was stated that REASON has left the planet for the time being. 

There seem to be two separate discussions going on here.  One involves a lot of hand-wringing and moralizing.  The other involves some bare-bones facts.  I don't see that any line can be drawn in this thread giving one side claim to the title of those who "do obviously care about their fellow man".
AIDS isn't for sissies.

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #61 on: October 13, 2007, 12:44:23 AM »
Thunder

Do you even have a thought on the topic or are you just here to trash people like Wesley and those who might agree with his thoughts on the subject.  I mean if you have an opinion on the topic I am sure we would love to hear it.  But honestly this petty gripping is only serving to discredit you.  Please deal with the topic and leave the personal trashing for a PM.

I really hope that we can get back to the topic and hear some honest thoughts on it.  I think we were trying to discuss the pro's and cons of this routine testing.
Mikey

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #62 on: October 13, 2007, 01:11:27 AM »
Thunder

Do you even have a thought on the topic or are you just here to trash people like Wesley and those who might agree with his thoughts on the subject.  I mean if you have an opinion on the topic I am sure we would love to hear it.  But honestly this petty gripping is only serving to discredit you.  Please deal with the topic and leave the personal trashing for a PM.

I really hope that we can get back to the topic and hear some honest thoughts on it.  I think we were trying to discuss the pro's and cons of this routine testing.

I don't give a rat's ass how far my line of credit extends with you.  I really and truly don't. 

The suggestion that Moffie put forth (and that I share) has nothing at all to do with the moral correctness of universal testing, but everything to do with the financial realities behind it.

And if that hasn't gotten through by now, you're slower and thicker than any syrup your state has ever produced.

I recommend you follow your own advice and reread the posts above without inserting yourself too much in them.


« Last Edit: October 13, 2007, 01:53:04 AM by thunter34 »
AIDS isn't for sissies.

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #63 on: October 13, 2007, 01:16:49 AM »
One thing which we haven't discussed is how the horrible meth problem contributes to the spread of HIV.   It's really unfortunate and I hope people will put their meth pipes down and listen.

I know I did and I'm glad.   I really do feel for those others still apparently struggling with it!

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #64 on: October 13, 2007, 01:32:11 AM »
One thing which we haven't discussed is how the horrible meth problem contributes to the spread of HIV.   It's really unfortunate and I hope people will put their meth pipes down and listen.

I know I did and I'm glad.   I really do feel for those others still apparently struggling with it!

Wesley

WTF?   Where the fuck did all that  come from?  What possible tie does that have to the topic at hand?

Oh.  Oh, wait...I get it.  You're like trying to suggest that anyone who hasn't walked in lock step with you is some meth addled mess, right?  That's supposed to be another one of those snarky passive aggressive things, isn't it? 

I'm right, aren't I?

*giggle*   

Oh, how very sad for you.
AIDS isn't for sissies.

Offline AustinWesley

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Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #66 on: October 13, 2007, 01:43:01 AM »
Still not seeing where this is coming from in the context of this thread...other than for the reason listed above.

AIDS isn't for sissies.

Offline Miss Philicia

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #67 on: October 13, 2007, 01:46:10 AM »
"I’ve slept with enough men to know that I’m not gay"

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #68 on: October 13, 2007, 01:47:45 AM »
LOL, too funny Philly!

Well I'm off to bed, but thanks for the laugh!
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #69 on: October 13, 2007, 01:52:17 AM »
BWAH HA HA !!  Me, too.  That was hilarious.
AIDS isn't for sissies.

Offline anniebc

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #70 on: October 13, 2007, 02:50:49 AM »
Quote
Please deal with the topic and leave the personal trashing for a PM.

I thought this might be a good time to let you know, seeing as you have only been here 3 days, that you DO NOT use the PM's to trash anyone... so you can stop advising people to do this.

Jan
-----------------------------------------------------------------------
Never knock on deaths door..ring the bell and run..he really hates that.

Offline jack

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #71 on: October 13, 2007, 06:23:25 AM »
Everytime someone suggested mandatory testing in the 80s or 90s they were branded a nazi or fascist by aids groups and those on the left.  I believe most politicians are afraid to even touch this issue.  The left said this was a slippery slope that would lead to further discrimination and possible internment of all hivers.  No politician is his right mind is gonna touch this for fear of being smeared again.  Another problem is the small number of US deaths from Aids as compared to other causes and diseases
It might even be fair to say that US hiv is falling off the radar of many. The death rate from AIDS in the US in 2005 was estimated around 17000.  Its hard to find AIDS on most charts for causes of US deaths. Maybe when they say AIDS  or HIV is manageable they are really talking about it being manageable for the politicians.

Offline Dachshund

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #72 on: October 13, 2007, 06:43:20 AM »
Everytime someone suggested mandatory testing in the 80s or 90s they were branded a nazi or fascist by aids groups and those on the left. 

Maybe that's because the leading conservative voice at the time, William Buckley, suggested in all seriousness that the government tattoo the ass of every homosexual man.

Offline Tim Horn

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #73 on: October 13, 2007, 07:21:02 AM »
Well, at least we have clear-as-day evidence here of how someone's words posted to the Forums gets minced and used against them:

What Moffie said was this:

I humbly offer that until tens of thousands show up in emergency rooms with full out PCP, then nothing will be done.

This was interpreted by Mike to mean this:

Are you people serious  I can't believe that you would suggest that until thousands of people show up in emergency rooms with full out PCP, then nothing will be done.  Are suggesting that we do nothing and just wait till thousands of people are dying because it cost to much to test them.  You can't possiblily think that the best way to handle this is to do nothing.

And then Wesley chimed in with this:

Frankly, I'm not even going to address the ridiculous other suggestions that we just wait until people rot and die.   It frightens me that some who claim to be such long time advocates have such apathy and beyond.

This is precisely how flamewars start in these Forums.

I fail to read Moffie's comment to mean that he is defending apathy until tens of thousands of PCP cases are diagnosed through emergency rooms. Moffie made it quite clear that he supports the idea of universal testing, but is also pointing out the grim reality of things -- that the infrastructure simply isn't in place to do what the CDC REALLY wants here: not only to make testing available to everyone, but to link newly diagnosed people to the medical and social services they need to keep themselves healthy (and, consequently, reduce their risk of transmitting their infection on to others). And what's missing here are funding mechanisms and the infrastructure to provide these necessary services. Moffie's point here is that some states may not realize that it's likely cheaper to implement universal testing and linkage to HIV primary care until scores of late-diagnosed people start racking up insane hospital costs.    

Quite possibly, state healthcare systems WON'T realize what a good deal universal testing and linkage to preventive care and treatment is until they're once again shelling out billions of dollars to care for thousands of HIV-positive people who don't present until they require costly hospitalization and critical care. How anybody could think that Moffie -- or anyone else here, for that matter -- is advocating this or defending this is beyond me. This is simply pointing out a grim -- and likely -- scenario that needs to be dealt with. Mike, where does Moffie imply that the "best way to handle this is to do nothing?" Wesley, where does Moffie suggest "that we just wait until people rot and die." Quite frankly, you're both accountable for denigrating this discussion with such disingenuous and intentionally misinterprative comments.

Okay, so we do away with comprehensive pre- and post-test counseling on the assumption that HIV isn't -- or at least shouldn't be -- as stigmatizing as it was back in the 80s and early 90s. Fine. But I'm willing to bet every penny that I have that there will be a fierce resurgence of stigma if all we're providing are test results without linkage to the support and services A LOT of HIV-positive people need. Fact is, the universal testing guidelines are primarily aimed at emergency departments that -- even in this day and age -- are the place where a lot of disenfranchised people receive their primary care. They enter an E.D. for, say, an abscess... agree to be tested for HIV... find out they're positive... and end up being discharged from the E.D. without being directly handed over to medical and social service providers because such programs are already overburdened and simply unable to take on additional patients. You want to talk about stigma? So they've found out they're likely positive, armed with nothing more than a sheet of paper suggesting that their OraQuick assay results need to be confirmed and their fears and anxieties. Unless the Ryan White titles, Medicaid, and Medicare have concrete funding mechanisms in place to pay for the direct-linkage-to-care services that are so desperately needed, it's no wonder that state Departments of Health and legislatures and dragging their feet adopting this CDC mandate.

Another supporter of unversal testing who realizes that there are a hell of a lot of kinks to work out before it becomes a workable option,

Tim Horn      
« Last Edit: October 13, 2007, 08:00:52 AM by Tim Horn »

Offline Miss Philicia

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #74 on: October 13, 2007, 10:56:04 AM »
Everytime someone suggested mandatory testing in the 80s or 90s they were branded a nazi or fascist by aids groups and those on the left. 

Pray tell, as a long term survivor, how did you benefit from the actions of those nasty, extremist ACT-UP fags?
"I’ve slept with enough men to know that I’m not gay"

Offline Miss Philicia

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #75 on: October 13, 2007, 11:01:46 AM »
ps:  And many thanks to Mr. Tim Horn for an appropriate summary of this thread and it's somewhat disingenuous machinations in various postings, as well as a more than generous dash of sane realism regarding the actual topic, in a thread I've studiously read but studiously avoided posting in.
"I’ve slept with enough men to know that I’m not gay"

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #76 on: October 13, 2007, 11:56:04 AM »
ps:  And many thanks to Mr. Tim Horn for an appropriate summary of this thread and it's somewhat disingenuous machinations in various postings, as well as a more than generous dash of sane realism regarding the actual topic, in a thread I've studiously read but studiously avoided posting in.

I echo philly's appreciation, Mr. Horn.  An excellent post.
AIDS isn't for sissies.

Offline AustinWesley

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #77 on: October 13, 2007, 12:33:26 PM »

Okay, so we do away with comprehensive pre- and post-test counseling on the assumption that HIV isn't -- or at least shouldn't be -- as stigmatizing as it was back in the 80s and early 90s. Fine. But I'm willing to bet every penny that I have that there will be a fierce resurgence of stigma if all we're providing are test results without linkage to the support and services A LOT of HIV-positive people need. Fact is, the universal testing guidelines are primarily aimed at emergency departments that -- even in this day and age -- are the place where a lot of disenfranchised people receive their primary care. They enter an E.D. for, say, an abscess... agree to be tested for HIV... find out they're positive... and end up being discharged from the E.D. without being directly handed over to medical and social service providers because such programs are already overburdened and simply unable to take on additional patients. You want to talk about stigma? So they've found out they're likely positive, armed with nothing more than a sheet of paper suggesting that their OraQuick assay results need to be confirmed and their fears and anxieties. Unless the Ryan White titles, Medicaid, and Medicare have concrete funding mechanisms in place to pay for the direct-linkage-to-care services that are so desperately needed, it's no wonder that state Departments of Health and legislatures and dragging their feet adopting this CDC mandate.

Another supporter of unversal testing who realizes that there are a hell of a lot of kinks to work out before it becomes a workable option,

Tim Horn      

Hey Tim,

I appreciate you bringing the topic back on track.    I do respectfully disagree that routine testing would somehow bring back the stigma and stereotyping that existed in the 80s.   I think it's entirely possible that if we ignore routine testing and only target perceived "high risk" groups that we could see something like the 80s with our hospital and healthcare systems overtaxed by a whole influx of undiagnosed people taking up hospital space and resources.  

I fully realize our medical system is flawed and underfunded, but I previously mentioned several scenarios as to why I feel that routine testing if done properly could and would save lives and money by keeping people healthy.   Believe me, you aren't going to get an agrguement from me that this patchwork of private and public medical care in this country is perfect.

It's my opinion that routine testing would actually help in the long run to break down stigma and stereotypes.   Many of the previous "high risk" groups are still the primary focus of prevention efforts while new high risk groups are quickly forming.   HIV is now rapidly increasing among our senior population and many other demographics that were previously ignored.

I think there has been some confusion over the difference between "routine" and "mandatory" HIV testing.   I want to make it clear that I'm in favor of routine testing not mandatory.  

Whether counseling is available to everyone or not I still feel that routine testing should be available and I think it would help end some of the stigma and breakdown those stereotypes that only gay men and drug users are the only ones who get HIV.    Obviously, women are a high risk category and many ethnic groups and minorities who go largely ignored still.

I don't think doctors and clinicians should have to fill out reams of paperwork and provide pre diagnosis counseling just to do a simple blood test to confirm an HIV diagnosis.   Even still in the medical community those old stereotypes play a large role as people continue to go undiagnosed and misdiagnosed because they don't fit some perceived "high risk" group.  

My opinion is that to get a better handle on this epidemic and acquire adequate funding we should help push those hold out states towards routine testing.   I think it will help breakdown the stigma and stereotypes if we have a very accurate breakdown of the demographics representing everyone who's HIV+ while simultaneously preventing further infections!


Respectfully,

Wesley








« Last Edit: October 13, 2007, 12:35:35 PM by AustinWesley »
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #78 on: October 13, 2007, 12:36:56 PM »
Perhaps we can clear up some terms that may help to keep us all on the same page here.  I have seen the terms “mandatory testing”, “Universal testing”, “Routine testing” used.

Mandatory testing, would rightly so, imply that all people be tested like it or not.  This is not the intent of these guidelines nor the suggestions of them.

Universal testing, would to me, imply that all people who seek medical attention be given an HIV test with or without consent.  Again this is not the intention of these guidelines.

Routine testing, would imply that an HIV test be done as part of routine testing .  Now as with any “routine test” be it a Hep screen or CBC panel or HIV test the Patient has the right to refuse or opt-out of the test.  By terming the HIV test as a “routine test” this allows the test to be done without a special consent form(s).  That is it would fall under the general consent form all people sign.  People would still be told that an HIV test is being ordered but it would become part of routine tests thus diminishing the stigma associated with an HIV test and eventually (hopefully) to relieve the stigma of HIV altogether.

 

On the point of funding.   I have heard time and time again how funding for “universal” testing is just not there.  I think it could be.  I know it could be, (just a point of reference) if we can find $400 million a day to fight another countries civil war, then surely we can find the money to test people for HIV, and to offer the counseling they want and or need.  These guidelines don’t require medical services  to be the sole source of counseling, CBO’s and ASO’s are considered acceptable sources for any needed counseling.  I will concede that ASO’s are funded on the number of  HIV clients they have, thus it would stand to reason that if more people are getting tested and testing positive that more funding would be made available.

 

I can only see many of these recommendation as a way to help mainstream an HIV test and destigmatize an HIV diagnoses.  I would hope that all of us would welcome the day when saying “I have HIV” was no more likely to cause fear or isolation than saying “I have Cancer”.    This could be a step in the right direction, and I think it is.  Nothing new is without it’s flaws, but I don’t see that waiting until all the flaws are solved is the way to bring the spread of HIV to a halt.  Only through people knowing that they have HIV can we hope to educate them and begin to truly make a difference in stopping new infections.  If one does not know they have HIV then they don’t know they are spreading it to others.  Surely this is common sense.   Society is not blaming the people who don’t know they are positive for the spread of HIV, they are blaming the ones who do know.  I have to believe that if more people knew they had HIV less people would be spreading it.  Make no mistake I am NOT saying that only people who do Not know they are positive are the cause of HIV being spread.  I know full well that there are some out there who do know they have it and continue to carelessly spread it.  My point is That the best way to bring about change is through the knowledge of ones status.

Mikey

Offline Miss Philicia

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #79 on: October 13, 2007, 01:54:01 PM »
Did a post disappear on this thread on purpose or am sketching out from AIDS brain fog and ground up klonopin again?
"I’ve slept with enough men to know that I’m not gay"

Offline MOONLIGHT1114

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #80 on: October 13, 2007, 01:58:00 PM »
It moved, I was reading and refreshing and *poof* it was gone.

Check the Public Apology thread, philly.

HIV+ since '93, 1/12 - CD4 785 and undet.   WOO-HOO!!

Offline Miss Philicia

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #81 on: October 13, 2007, 02:14:38 PM »
Damn.  I was really hoping my sedatives had kicked in :)

(Unfortunately I don't have any at the moment)

::lamentations ensue::
"I’ve slept with enough men to know that I’m not gay"

Offline jack

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #82 on: October 14, 2007, 06:40:50 AM »
as usual,I am attacked for stating a fact. I did not say that Hivers and the lefts fears were unfounded or without merit, I simply stated that in 80s and 90s whenever someone suggested mandatory testing they were smeared and attacked. I did not say that I didnt benefit from Aids activists. I did not call anyone a fag.
Fear of smear and the small amount of deaths from HIV, compared to other causes of death means no one in politics senses any need for mandatory testing.
As a person with HIV I am very happy we weren't rounded up or interned in the hysteria and panic of late 80s and early 90s, but I always think its interesting to wonder what something like that would have done to the spread of HIV in the US.

Offline jack

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #83 on: October 14, 2007, 07:25:28 AM »

To not test all for fear of a return to stereotypes or stigmas is not a good reason.  We don't wanna know who may have HIV because we are afraid of creating stigma for those already infected? Sorry, but thats not a valid reason if you are really interested in stopping HIV.  What is more important, the quality of life of those already infected or stopping new cases of HIV? Lets just put our  heads in the sand maybe the problem will go away. Should those of us who were stupid enough to get this virus be the right persons to decide how to stop the spread of it?  Maybe, but not if we our main concern is stigma and stereotypes.

A universal health care or government administered health care system(is that the same thing?) will mean health care rationing.  Any time a government attempts to control markets or prices, rationing of some form will occur and black markets are created to solve the problem.  What happens ten years from now if we have National Health care and some republican,who as we all know want all gays to die, becomes President or they control the congress and they make a decision certain treatments or drugs are gonna be just too expensive for patients or even to be developed? Its going to be fun.  Instead of the market and insurance companies determining how and what people are treated with,those who have political power will be making those decisions. So is it possible if you decrease the number of people with HIV,that patient group will lose what little political power it has now and those already infected will be told they are just too expensive to treat? In fact since testing is so expensive,wouldnt it be cheaper just to let people live in ignorance and maybe they will just die and save us the cost of drugs?

Offline Dachshund

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #84 on: October 14, 2007, 08:16:24 AM »
What happens ten years from now if we have National Health care and some republican,who as we all know want all gays to die, becomes President or they control the congress and they make a decision certain treatments or drugs are gonna be just too expensive for patients or even to be developed? Its going to be fun. 

Gee I wonder? What WOULD it be like to have Republicans control the White House and Congress? I guess we'll never know. Of course we know Republicans don't want all gays to die, if they did there would be no Republican Party.

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #85 on: October 14, 2007, 12:07:33 PM »
Peter,

I admit that my statement to Mikey was done in frustration, and also probably just a bit of anger......  I felt my statement to him let him know that I was finished, and couldn't get through to either him or Austin.  That being said, if I were in your shoes, I would have also given me a warning.  I apologise for not keeping my emotions in check in this very important discussion.

Rev. Tim,

Thanks for your very pointed post which tries also to explain one of the least discussed issues in HIV/AIDS work in this capitalist democracy.  I truly appreciate your efforts.

Tim Horn,

Your non emotional, clear description of the real issues that are the back story of "why 30 states have not fallen into lock step with this very unusual government" really helps to define the reasons why these suggestions from the CDC are not being followed.  I thank you.

Now for the comments that inspired this post, I find that some of the posters have created "facts" that are at the very least, misleading and I feel compelled to make comment before this thread drops into infinity.

Mike said this:
On the point of funding.   I have heard time and time again how funding for “universal” testing is just not there.  I think it could be.  I know it could be, (just a point of reference) if we can find $400 million a day to fight another countries civil war, then surely we can find the money to test people for HIV, and to offer the counseling they want and or need.

I nor anyone else I have worked with in HIV have ever suggested that the money couldn't be found, we all know that this is very true, and not a question in the richest country on the planet.  Then he follows up that assertion with "I think it could be".  Yes, it could, but just how is that going to happen in a Capitalistic driven health care system, without government intervention?  Mandates from the government are never followed without the attendant funding for such edicts, NEVER.  I don't care if it is pollution in California or edicts in the healthcare system, it just doesn't happen.

Then this:These guidelines don’t require medical services  to be the sole source of counseling, CBO’s and ASO’s are considered acceptable sources for any needed counseling.

I don't know how things work in Vermont, but I do understand Ryan White, and I know that seldom do Doctors working in private practice who are not Infectious Disease Specialists, interact with AIDS Service Organizations.  I also know that counseling services and mental health counseling are one of the six mandated line items required before any state can be funded for Ryan White contracts, but still, I have almost never seen doctors in private practice work in parallel with most ASOs.  This would add so many cumbersome issues to the mix for the newly diagnosed that many would go running into the bush just to get away from this suggestion. 

Finally on this issue, AIDS Service Organizations are not automatically funded for testing at all, because Ryan White funding comes from HHS, which is the "services" side of the National Institutes of Health.  The CDC is the source for Testing and post test Counseling.  These monies are two very separate funding streams, and only recently, (in the last month) has there ever been any attempt to have these two very separate funding streams to be joined for better communication and more complete coverage of the needs.  When an ASO wants to be funded for testing and counseling, they must apply to their state's governments for that funding, which then comes out of the Prevention funding grants from the CDC to the individual states.  It is very dangerous to all of our understanding to make blanket and vague statements about funding HIV/AIDS services in the United States, because if you don't know the details, then you miss out on ever solving the real issues, including Testing and Counseling.

And then this very misleading statement;
I will concede that ASO’s are funded on the number of  HIV clients they have, thus it would stand to reason that if more people are getting tested and testing positive that more funding would be made available.


What he states here is true to a point.  No ASO is automatically funded and the states must now apply for new Ryan White Contracts every three years.  In that length of time, each year ASOs also have to apply to the States individual HIV/AIDS programs through their own state Department of Health.  They are funded X number of dollars for each client and as the client base grows they are funded each year for their increase in client load depending on the amount of money left in the budget for the three year span.  It is not automatic that the monies will magically arrive based on the numbers of new clients, and many states have sustained, and still do, waiting lists for not only drugs but for services.  Waiting lists are a subject that we in the field never thought would come about, but the fact is, this current administration has raped the Ryan White funding through their policy of flat funding, for nearly seven years now.  His statement assumes a caring government, a well oiled HIV program for every state, and in the end, it just isn't true!  Also it is very important to remember that not all states have a huge population of ASOs, and those states use Ryan White through their states Health Departments because that is the final stop for HIV money coming from HHS.  Ryan White legislation mandates that the states search out all qualified Nonprofits to take the funding, but in some states, this just is not the case due to the lack of Nonprofit ASOs and in the end the programs are integrated into the Counties' health departments.  These states usually have far higher spending and far fewer real dollars for their clients.

And finally:

I can only see many of these recommendation as a way to help mainstream an HIV test and destigmatize an HIV diagnoses.  I would hope that all of us would welcome the day when saying “I have HIV” was no more likely to cause fear or isolation than saying “I have Cancer”.    This could be a step in the right direction, and I think it is.  Nothing new is without it’s flaws, but I don’t see that waiting until all the flaws are solved is the way to bring the spread of HIV to a halt.  Only through people knowing that they have HIV can we hope to educate them and begin to truly make a difference in stopping new infections.  If one does not know they have HIV then they don’t know they are spreading it to others.  Surely this is common sense.   Society is not blaming the people who don’t know they are positive for the spread of HIV, they are blaming the ones who do know.  I have to believe that if more people knew they had HIV less people would be spreading it.  Make no mistake I am NOT saying that only people who do Not know they are positive are the cause of HIV being spread.  I know full well that there are some out there who do know they have it and continue to carelessly spread it.  My point is That the best way to bring about change is through the knowledge of ones status.


I don't know what kind of nirvana Mike thinks this country has turned into, but last time I checked, this is just not going to happen.  First off, most people in the male straight side of this discussion, in my experience seldom admit their poz status, and far more of them than not, don't feel any obligation to disclose or use condoms in their sexual pursuits.  I know this is a very general statement, but remember this is taken from my experience both in the work and in my time on the road driving my Kenworth.  Most of the straight men I have met are totally unwilling to deal with their infection head on.  Please don't all you straight guys beat up on me for this, but I think as you progress in your time living with this disease, you will also find my statement to be closer to the truth than not.  This is not to say that Gays are free from criticism, for that would also be not true, we all know that many gays will not disclose and really could give a shit if they pass it on to anyone.

All in all, I don't think that some of the people posting in this thread have really done their homework and really don't know how HIV services in this country really operate.  Many of you have followed me for a long time here, and to the nearest nit- pik, you all know I always advocate for doing your homework first.  Always find out how the system works and how it is funded, because only then will you ever come close to getting anyone in government to listen to your pleas for more money to fund universal, mandatory or any other kind of complete surveillance. (testing)

Love,
« Last Edit: October 14, 2007, 12:14:37 PM by Moffie65 »
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline Miss Philicia

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #86 on: October 14, 2007, 12:33:59 PM »
It is very dangerous to all of our understanding to make blanket and vague statements about funding HIV/AIDS services in the United States, because if you don't know the details, then you miss out on ever solving the real issues, including Testing and Counseling.

So damn true.  A good friend of mine is Co-Chair of our local Ryan White Planning Council, and the pieces he tells me really do show that this is a very involved, intricate process on various levels.  Most people here have no clue, and I don't mean that in a bad way necessarily, it's just a fact.  Frankly I have little clue how it all works, but I do know I have a basic knowledge of it from years on these programs that exceeds the average on this board, yet even then I can't comment fully on it all as I realize in the final equation I don't know diddly-squat.  I generally DO know where to go when I need an answer, and it varies so much by locality it's even harder to offer advice outside the specifics of each state.
"I’ve slept with enough men to know that I’m not gay"

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #87 on: October 14, 2007, 06:32:31 PM »
HI All

I stand by my post and my opinions 110%

I have lived with HIV for 24 years.  I have, in that time, also help with the founding of the largest ASO in the state.  I have worked with this ASO many times including the funding process.  I have work with the State department of health on Aids issues and on funding isses.  I am far from ignorant on any of this issues.

Since I have come into this thread I have been personally attacked, and sworn at.  I will not engage in this name calling nor will I partake in personal attacks in the topics.  If any one would like to discuss this issue in a civil manor I'll will be happy to respond.  I may be new to this site but I still don't see the need for people to be rude or make derogatory remarks.  I would expect people to be more mature in such a setting.
Mikey

Offline Dachshund

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #88 on: October 14, 2007, 07:39:47 PM »
I'm sorry to lead this further off topic, but I do feel I need to respond to your accusations. I think Tim Horn did a brilliant job in explaining to you why people reacted the way they did and there really isn't much more I can add to that. However, I don't think your hands are entirely clean in all this and I will tell you why.

In your very first post out of the box, no introduction, knowing nothing about you, you say this:

I read  some post and nearly laughed and others I sat here in horror to think and see that people could really think in such ways.

You moderate your own site and obviously have been round long enough to know that this sets off warning bells. I would think as a moderator of your myspace you might become a bit suspicious, welcome the person and ask them to tell you a little about themselves. If I remember correctly, you didn't even reveal your status. Heck, I'm just finding about it now. Secondly, I'm sure you would agree generalizing about how an entire group thinks can certainly put people on the defensive.

Here's the deal, and I'm being completely honest. After reading a few of your posts, checking out your profile and seeing where it all linked, and maybe I'm being a bit of a conspiracy theorist, I believed there was more to this than met the eye. If I was wrong so be it.

That said, after 27 years of da aids I think sometimes we think we know it all and discount the opinions of others. I know I can be guilty of that. ;)

Remember your 110% convictions are no more valid than any other persons 110% convictions. I would also like to suggest that if you feel like you are being attacked or sworn at, report it. Hopefully, you can put all that other stuff behind you and focus on the positive that is Aidsmeds.


Hal













Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #89 on: October 14, 2007, 09:42:06 PM »
Thank you for your reply Hal

I would like to try to keep this on topic.
Mikey

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #90 on: October 15, 2007, 02:03:59 PM »
Hi all I am new to this group but I have been reading and I must say there is a LOT of reading to do.

Points that shocked me;

I read in one post ( don't ask me wich one there are to many to go back through.)  that people not knowing their HIV status is not the cause of the spred.  You have got to be joking!!!  you can not tell me that ignorance is not the problem. 



Hi Mike,

Welcome.

Since I believe you are talking about my point, I thought I would address this issue. 

First since you are new, may I give you first a heads up that saying it is too much of a bother to actually cite the person you are quoting (or at least whose comments you are discussing) than many may just write off your entire post as they will question if you can even bother to make certain that you have what you are quoting or talking about correct.

In this particular incident - I can say that you did not and actually misrepresented both what I said and the point I was making.

For the record , the complete quote is: It is not people not knowing their status that is the cause of the spread of the virus sexually - it is people not using condoms that is the cause of the virus being spread sexually.

Mike - I'm sure you would agree that neither ignorance nor knowledge mean one iota to the physical efficiency of virus transmission during a sexual encounter;  Latex on the other hand....

You see, if you read and understood the the context of what I wrote you will note that my point is that testing doesn't necessarily equate people really knowing their correct status to begin with.   It  also doesn't equate people using condoms...and,  by anecdotal evidence available with more than a few hours of reading material of case examples on these very forums, there are way too many people who in fact had sex without condoms simply because they thought their test results equaled their ability to do so.

Understand that I am not against routine testing at all,  and I do detest the bureaucracy that plagues the medical profession and is a barrier to some testing being done. However my original post was in direct response to a statement by original poster of the validity of tying testing and counseling (which in case you misunderstood was the main cause of his reason to argue his point.) 

Quote
I find it outrageous that people are not being screened for HIV and going untreated and undiagnosed for some bullshit "counseling" guidelines implemented by ass backwards and antiquated ideas.

I trust you now can appreciate my point and will not misunderstand or misrepresent it.


Offline jack

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #91 on: October 15, 2007, 04:00:47 PM »
Now I understand,testing makes no sense because we are Godless animals without any conscious or  brains and even if we know we are positive we will still fuck anything and everything that walks.  What a sad and pathetic view of mankind. I hope its not true. I guess I am one of the exceptions to your rule, I know for a fact I haven't spread HIV since I became aware that I was positive,not because of latex but because I refuse to spread this shit.

I get it now, if we spend more money on rubber advertisements we can cure the spread of HIV and we can forget about testing.

You are either for or against spreading HIV. Stopping the spread of HIV should trump all other interests, those who wish all to abstain,those who wish us all to rubberize and fuck ourselves to death,and those whose concern is the stigma of HIV. Both rubbers and abstinence stop the spread of HIV,so both should be promoted. Testing will help stop the spread of HIV. There are humans with the moral integrity and will power strong enough to never spread the Virus once they know they have it.  Its much more difficult to put on that rubber when you dont know if you have it or your partner has it.
We can try to shift the responsibility on the entire population,but in reality the responsibility for stopping the spread of HIV lies with those infected and no one else. Not our health care system and not our government. If everyone knows their status and everyone who knows they are positive uses protection or abstains,it will stop.

If we dont have the will power to control the spread of hiv the government at some point is gonna do it and I dont think anyone wants that.

Offline Matty the Damned

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #92 on: October 15, 2007, 04:04:20 PM »
If we dont have the will power to control the spread of hiv the government at some point is gonna do it and I dont think anyone wants that.

As usual Jakey, your posts sound like they were written by Lyndon La Rouche himself. I'll just focus on the last part.

In Australia the government took control of "preventing the spread" back in the mid-1980's and it worked a treat. HIV is essentially contained with the homosexual male community.

MtD

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #93 on: October 15, 2007, 04:06:13 PM »
Hi Iggy

Thank you for the kind and understanding response.

I trust you now can appreciate my point and will not misunderstand or misrepresent it.  I will try my best.

I know that this is a hot topic and there are many facets to it.  I will try not to step on toes as we try to work our way throught this.

Ok here goes.  LOL  One point I think we (at you and I) do agree on is that "routine testing" is Not a bad idea in theory.  If I have not made it clear and I may not have yet, I agree with you on and I do detest the bureaucracy that plagues the medical profession and is a barrier to some testing being done..  By this I think you are referring to the special consents and forms If this is the case I whole heartedly agree.  I am in favor of the HIV test being done without the need of "special consent forms".  I see no reason why it should not fall under a general consent.  So long as the person who is being tested is told that an HIV test will be performed as part of the standard blood work, and has the oppertunity to opt-out of it.  I would not condone involuntary or Mandatory testing, except in the case of Pregnant women.  In this case I feel that "Required testing" should be done for all pregnant women.  My reason is simple because another life could be spared having to live with HIV, as we know it is now possible for a + mother to give birth to a negative child with proper treatment.  Oh I hope I didn't step on to many toes there.

Now on to Knowing vs not knowing vs condoms  I know that not every one who know they have HIV will use a condom.  A sad but none the less true fact.  However Many that do now know they are HIV+ do try to reduce the risk of transmission.  It would be wonderful if every one used condoms every time but I know that won't happen, (if it did the human race would die off in a hundred years).  So what can we do about this.  Educate educate educate.  Now lets say (just to make a point ) that only 40% of HIV + people will use condoms (I picked the number out of thin air) Of the next 1000 people that find out they are HIV+ from Routine testing 400 will start using condoms that would not have otherwise been using them.  This will save thousands of lives even millions.  It may not be the whole answer but i think it is a good place to start.

This would in the long run save billions of dollars in our already stressed health care system.

Now if I may try to cover one more facet you hit on.  Counceling vs not counceling  I am not sure I have said a wholoe lot on this  or made myself clear on it but i will try.  I think voluntary counseling is good, meaning that if a person chooses to receive counseling pre or post testing that it be made available to them.  However I am not sure that madatory counseling is the best thing.  My reason is simple.  Not everyone will even hear what they are being told after hearing that they are HIV+  Many are in shock or dismay at the news and need time to absorb it before they can hear and understand what all of this means.  Some people would choose to know as much as possible right away.  I respect that and say give them all they can take.  Others may choose to seek the answers after they have had time to think.  For them a list of ASO's, ID specialists or even an appointment a few days down the road to discuss their options may be just what they need.  I would never suggest that people be tested and told the results and sent away without any support.  That would be just cruel.  So that's my opinion thus far.

I know there are many other aspect of this and I am sure we will hear about them too.

Mike
Mikey

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #94 on: October 15, 2007, 06:34:57 PM »

In Australia the government took control of "preventing the spread" back in the mid-1980's and it worked a treat. HIV is essentially contained with the homosexual male community.

MtD

How did they do it?  And by "contained with the homosexual male community", do you mean infection rates have steadied and/or declined within that community or do you mean that it has only remained a rampant problem within male homosexuals and hasn't been a significant problem outside of that group?  If so, what worked for the rest of the population that didn't for male homosexuals and why do you think that was so?

I recognize that's a lot to ask, but I'd appreciate getting as much response from you and the fellow Aussies on here if/when you can.  If it requires a separate thread, please do.
AIDS isn't for sissies.

Offline Matty the Damned

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #95 on: October 15, 2007, 06:44:13 PM »
Nah Timmy, we'll keep it in this thread. Fucking thing's gone to shit anyway so there might as well be a few posts with some redeeming value in it.

HIV infection is Australia is almost entirely restricted to homosexually active men because needle and syringe exchange programmes were implemented in the major states in the mid 80's. Queensland and Tasmania had followed suit by the early to mid 90's.

The idea is that you keep HIV out of your drug user population and it won't spread to the heterosexual community. That's what happened here. Our infection rates are going up but that increase is almost entirely amongst homosexually active men.

Clean needles and syringes are freely available here and it's not a criminal offence to be in possession of them.

MtD

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #96 on: October 15, 2007, 06:53:25 PM »
Nah Timmy, we'll keep it in this thread. Fucking thing's gone to shit anyway so there might as well be a few posts with some redeeming value in it.

MtD

We're on the same page there. 

Sounds like a healthy dose of sanity prevailed with the needle exchange programs - which works great for the heterosexual portion of the population, but it also makes me wonder what your perspective is regarding how the whole thing has been handled with regard to the homosexual segment.  Mind you, I get how containing the problem within that one segment actually works to the benefit of the population at large (lowered public health costs, prevention of spread to newborns, etc).  I would still like to get a feel for how well you think the government has addressed the problem where people like yourself are concerned.
AIDS isn't for sissies.

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #97 on: October 15, 2007, 06:55:51 PM »
Hi Iggy

Thank you for the kind and understanding response.

I trust you now can appreciate my point and will not misunderstand or misrepresent it.  I will try my best.

I know that this is a hot topic and there are many facets to it.  I will try not to step on toes as we try to work our way throught this....

Now on to Knowing vs not knowing vs condoms  I know that not every one who know they have HIV will use a condom.  A sad but none the less true fact.  However Many that do now know they are HIV+ do try to reduce the risk of transmission.  It would be wonderful if every one used condoms every time but I know that won't happen, (if it did the human race would die off in a hundred years).  So what can we do about this.  Educate educate educate.  Now lets say (just to make a point ) that only 40% of HIV + people will use condoms (I picked the number out of thin air) Of the next 1000 people that find out they are HIV+ from Routine testing 400 will start using condoms that would not have otherwise been using them.  This will save thousands of lives even millions.  It may not be the whole answer but i think it is a good place to start.

Mike,

I only quoted the above part of your post as most of what you wrote in reply to me wasn't part of my discussion with you - perhaps you just got lost on the many facets of this discussion, as you say.

Unfortunately the key point you seem to continue to miss happens to be the main point of my argument about tying counseling and education to testing.

It's not if people will or won't use condoms because of a test result saying they have HIV, it is if people understand what a test result does mean and doesn't mean whether it says they are HIV positive or negative and then acting erroneously because of lack of education and counseling.





Offline Tim Horn

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #98 on: October 17, 2007, 08:49:52 AM »
An interesting editorial in the November 15th issue of Clinical Infectious Diseases:


Universal HIV Testing: Is It Enough?

M. Goicoechea and D. M. Smith

Department of Medicine, University of California, San Diego

     Early diagnosis of HIV infection and timely access to medical care can improve treatment outcomes [1] and potentially decrease the risk of transmission [2]. In this issue, Keruly and Moore [3] report a decrease in the presenting CD4+ T cell count from 371 cells/mm3 in 1990–1994 to 276 cells/mm3 in 2003–2006 among patients newly presenting for HIV care in a large academic center in the United States. Despite significant advances in antiretroviral therapy and improved services for persons living with HIV infection, our health care system appears to be less capable of detecting the disease early in its course than it was nearly 2 decades ago. The authors conclude that national implementation of the 2006 Centers for Disease Control and Prevention recommendations for routine HIV testing in health care settings [4] will improve early detection and entry to care. But will universal HIV testing be enough? Although these data support the argument for mainstream HIV testing, they also highlight the issue of universal health care coverage.

     Keruly and Moore [3] report that, after stratification by demographic characteristics and HIV risk factors, median CD4+ T cell counts at presentation significantly decreased over time for women, men, black patients, and patients who reported intravenous drug use (IDU) and heterosexual exposures as HIV risk factors. One notable exception was for men who have sex with men (MSM). Presenting CD4+ T cells counts among MSM actually improved with time, from 280 cells/mm3 in 1990–1994 to 332 cells/mm3 in 2003–2006. Although proportions of patients of each sex and race remained relatively unchanged over time, the proportion of MSM and patients reporting IDU decreased, and there was a nearly 3-fold increase in persons listing heterosexual sex as a risk factor during 2003–2006.

     Two questions arise. First, are these changes in patient demographic characteristics driving the decrease in the presenting CD4+ T cell counts? The answer is probably not. Although MSM were the only subjects to have improved CD4+ T cell counts over time, these patients initially had the most advanced HIV disease at presentation, with only a modest gain of 52 cells/mm3 by 2003–2006. Conversely, all other groups had much higher presenting CD4+ T cell counts in 1990–1994, with large decreases over time, ranging from 76 to 174 cells/mm3.

     The second question centers on how HIV testing rates among patients receiving care at Johns Hopkins might differ from those of the rest of the nation. The 2002 National Survey of Family Growth was a population-based study of 12,571 men and women, ages 15–44 years, designed to determine the national estimate of HIV testing [5]. Overall, 50.7% of persons reported having ever been tested outside of the context of blood donation. Interestingly, testing rates were higher among African Americans and those with sex- and drug-related risk behaviors. Compared with data obtained from the 1995 National Survey of Family Growth study, which included only women, testing rates among African American women significantly increased, from 45.3% to 65.6%. If testing rates among African Americans are increasing nationally, then why do data from Johns Hopkins (more than three-quarters African American) suggest the opposite? The explanation may lie in where people receive their HIV testing. In the 2002 National Survey of Family Growth study, many persons received HIV testing from a private physician (39.5%) or a managed care organization (5.2%). In contrast, only 17.3% of all tests were performed in a public health clinic. The use of public clinics among the subgroup of persons with low incomes was higher, at 31.4%. As a provider receiving Ryan White CARE Act funding, the Johns Hopkins patient population contains mainly underinsured persons [6] who likely lacked general health care before their diagnosis of HIV infection. In the early 1990s, HIV care was largely concentrated in academic institutions or public facilities with access to clinical trials. In more recent years, HIV specialty care has become more available in managed care settings and among private physicians. Potentially, the Johns Hopkins cohort today contains fewer insured patients and serves a more disenfranchised population, with fewer opportunities for HIV testing, than was the case in the early 1990s. Because underinsured persons most often gain access to the health care system through public health clinics, emergency departments, and urgent care facilities, and these settings often have lower HIV testing rates than do private physician offices and managed care organizations [5], it is plausible that the Johns Hopkins HIV patient population is receiving diagnoses at a later stage simply because of the health care systems that are available to them.

     Another sobering finding in this study was the absence of improvement in the time from diagnosis to presentation for care among women, African Americans, and those with heterosexual risk factors. Although multiple factors likely contribute to this delay, those without prior health care may seek access to resources less efficiently even when resources are available. A universal health care system may help remedy this. As an example, universal health care is practically available in the United States for pregnant women, with an estimated 99% of pregnant women obtaining prenatal care [7]. Approximately 70% of women reported that they received HIV testing during prenatal care [7]; therefore, HIV infection is diagnosed earlier among pregnant women than among nonpregnant women [8]. In addition, low-income, HIV-infected women who had prenatal care were more likely to receive antiretroviral therapy during pregnancy and to have access to other medical services, such as substance abuse treatment, in the postpartum months [9]. Among pregnant women, primary care providers play a central role in HIV testing, access to antiretroviral therapy, and referral for other health care needs. We anticipate that similar benefits would occur for under- or uninsured, nonpregnant adults if access were available to primary care before HIV infection was diagnosed.

     HIV disease is a disease of poverty. In the United States, HIV infection disproportionately affects uninsured, low-income persons [10, 11], who constitute a vulnerable population that often has multiple health care needs. Despite these challenges, HIV infection–related morbidity and mortality continue to decrease [12]. Undoubtedly, much of this success is attributed to government-sponsored programs, such as the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which provides access to medical care after the diagnosis of HIV infection. Perhaps the best way to improve the prevention of HIV infection and decrease transmission is to provide similar health care services before HIV infection to those with the greatest need and highest risk for HIV infection. Although not completely analogous to the situation in the Unites States, in settings where universal health care systems are in place (i.e., Western Europe), HIV infection is still being diagnosed late among underserved, immigrant populations [13–16]. Taken together, these findings suggest that "universal" HIV testing also requires "universal" health care for there to be a significant impact on diagnosing HIV infection at the earliest stage possible [14]. As the United States and other resource-wealthy countries move forward to build health care infrastructure and scale-up antiretroviral therapy in resource-limited settings, it is a shameful commentary on our own health care system that the average CD4+ T cell count before the initiation of antiretroviral therapy in North America is similar to that of some underdeveloped countries in Africa [17].

References
1.  May M, Sterne JA, Sabin C, et al. Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies. AIDS 2007; 21:1185–97. First citation in article | PubMed 
2.  Barroso PF, Schechter M, Gupta P, et al. Effect of antiretroviral therapy on HIV shedding in semen. Ann Intern Med 2000; 133:280–4. First citation in article | PubMed 
3.  Keruly JC, Moore RD. Immune status at presentation to care has not improved among antiretroviral-naive persons from 1990 to 2006. Clin Infect Dis 2007; 45:XXX–X (in this issue). First citation in article 
4.  Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55:1–17; quiz CE1–4. First citation in article | PubMed 
5.  Anderson JE, Chandra A, Mosher WD. HIV testing in the United States, 2002. Adv Data 2005; 363:1–32. First citation in article | PubMed 
6.  McInnes K, Landon BE, Malitz FE, et al. Differences in patient and clinic characteristics at CARE Act funded versus non-CARE Act funded HIV clinics. AIDS Care 2004; 16:851–7. First citation in article | PubMed | CrossRef 
7.  Anderson JE, Sansom S. HIV testing among US women during prenatal care: findings from the 2002 National Survey of Family Growth. Matern Child Health J 2006; 10:413–7. First citation in article | PubMed | CrossRef 
8.  Wotring LL, Montgomery JP, Mokotoff ED, Inungu JN, Markowitz N, Crane LR. Pregnancy and other factors associated with higher CD4+ T-cell counts at HIV diagnosis in Southeast Michigan, 1992–2002. MedGenMed 2005; 7:1. First citation in article | PubMed 
9.  Warner LA, Wei W, McSpiritt E, Sambamoorthi U, Crystal S. Ante- and postpartum substance abuse treatment and antiretroviral therapy among HIV-infected women on Medicaid. J Am Med Womens Assoc 2003; 58:143–53. First citation in article | PubMed 
10.  Karon JM, Fleming PL, Steketee RW, De Cock KM. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health 2001; 91:1060–8. First citation in article | PubMed 
11.  Bozzette SA, Berry SH, Duan N, et al. The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. N Engl J Med 1998; 339:1897–904. First citation in article | PubMed | CrossRef 
12.  Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr 2006; 43:27–34. First citation in article | PubMed | CrossRef 
13.  Castilla J, Lorenzo JM, Izquierdo A, et al. Characteristics and trends of newly diagnosed HIV-infections, 2000–2004. Gac Sanit 2006; 20:442–8. First citation in article | PubMed | CrossRef 
14.  Delpierre C, Cuzin L, Lert F. Routine testing to reduce late HIV diagnosis in France. BMJ 2007; 334:1354–6. First citation in article | PubMed | CrossRef 
15.  Gilbart VL, Dougan S, Sinka K, Evans BG. Late diagnosis of HIV infection among individuals with low, unrecognised, or unacknowledged risks in England, Wales, and Northern Ireland. AIDS Care 2006; 18:133–9. First citation in article | PubMed | CrossRef 
16.  Longo B, Pezzotti P, Boros S, Urciuoli R, Rezza G. Increasing proportion of late testers among AIDS cases in Italy, 1996–2002. AIDS Care 2005; 17:834–41. First citation in article | PubMed 
17.  Egger M. Outcomes of ART in resource-limited and industrialized countries [abstract 62]. In: 14th Conference on Retroviruses and Opportunistic Infections (Los Angeles). Alexandria, VA: Foundation for Retroviruses and Human Health, 2007:87. First citation in article 


Offline Tim Horn

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #99 on: October 17, 2007, 09:15:43 AM »
When it rains, it pours... yet another recent article regarding obstacles to ruotine HIV testing. This one's in PLoS One, an open-access online peer-reviewed scientific journal:

Implementing Routine HIV Testing: The Role of State Law


Offline Dachshund

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #100 on: October 17, 2007, 10:01:05 AM »
Thanks Tim very interesting and as you mention very timely.
To me the crux of the problem is summed up in this one sentence:

 
  HIV disease is a disease of poverty. In the United States, HIV infection disproportionately affects uninsured, low-income persons

The voices of the poor are seldom heard. Even here at AidsMeds I don't think most of us really know what it is like to be uneducated and poor and positive.  Access to a computer alone makes all the difference in the world. With the click of our mouse we have access to experts, experience, compassion and friends. No question goes unanswered. As a group AidsMeds is far more homogeneous than most effected by the virus. I think (myself included) that we forget that actually we are the minority. We are a vocal, better educated minority, but a minority none the less.  It's a shame the majority of people effected by aids have no voice at all.

Offline jack

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #101 on: October 17, 2007, 10:27:32 AM »
sounds like another good reason to be rich

Offline Ann

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #102 on: October 17, 2007, 11:45:04 AM »
(quoted from the second article Tim Horn linked to) Although patients are more likely to test when their physicians suggest it many physicians do not do so because pretest counseling takes considerable time and discussing sexual and drug behaviors that risk transmission may be uncomfortable.

I can understand talking about drug use may be uncomfortable - because of legal issues - but sex? I think it's high time humanity grew up and abandoned this giddy, guilt ridden attitude toward sex it has. Everybody does it, outside of a tiny minority. We're built to have sex. It's hardwired into our brains. It not only ensures survival of the species, but it is also a social bonding mechanism which ultimately results in a better survival rate as well. 

I can't think of a more normal, natural aspect to our lives. Sex. What the hell is the big deal? People pussy-foot around serious sexual discussions, but will suck up ever last morsel of porn, soap-operas, sex-sells advertising, romance novels, love stories... etc ad nauseum. But ask people to talk frankly about protecting themselves from a deadly disease? They go bright red and say they couldn't possibly talk about it.

World - grow up and get over the fact that people have sex so we can do something constructive to end this damned pandemic. 

Sheesh.

Ann
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #103 on: October 17, 2007, 12:55:54 PM »
The voices of the poor are seldom heard. Even here at AidsMeds I don't think most of us really know what it is like to be uneducated and poor and positive.  Access to a computer alone makes all the difference in the world. With the click of our mouse we have access to experts, experience, compassion and friends. No question goes unanswered. As a group AidsMeds is far more homogeneous than most effected by the virus. I think (myself included) that we forget that actually we are the minority. We are a vocal, better educated minority, but a minority none the less.  It's a shame the majority of people effected by aids have no voice at all.

I think this very thing played directly into the anxiety and depression that fueled my friend Michael's despair.  It wasn't the whole of it, of course, but it was a significant part of it.  It was for this very reason that many of his medical problems had begun to mount, and for this reason that I had become resolved to try to assist him in better understanding his health situation.  That was what I was trying to communicate in earlier threads about him - that he represented that larger segment of the HIV population without more of a voice in his own care. 
AIDS isn't for sissies.

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #104 on: October 17, 2007, 02:15:16 PM »
I would like to add my voice to the chorus in thanks to Tim for those two very good posts.  The articles are very good at defining and expressing the need for all to be involved in the change we would like to see nationally.

Thanks once again.

Love,
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #105 on: October 18, 2007, 07:24:28 PM »
Thank you Tim for posting this report.

While the statement  Early diagnosis of HIV infection and timely access to medical care can improve treatment outcomes [1] and potentially decrease the risk of transmission [2].    does support the CDC’s recommendations for Routine testing as they would in fact detect and HIV infection far sooner than waiting  for more serious conditions to present.   This would in fact reduce the over all health care costs and make the treatment of HIV easier and more successful.  This report also suggest that a “universal “HIV testing also requires "universal" health care for there to be a significant impact on diagnosing HIV infection at the earliest stage possible [14].  It also clearly states that Despite these challenges, HIV infection–related morbidity and mortality continue to decrease [12]. Undoubtedly, much of this success is attributed to government-sponsored programs, such as the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which provides access to medical care after the diagnosis of HIV infection.    While a universal health care system may in the short run cost more, it will in the long run cost less and save lives.  By early detection of HIV people can make the changes most of us have since our own HIV diagnoses, i.e. use of protection for ourselves and others, healthier living and so many other changes most of us have made to insure that not only will we survive but other will not become infected.  With early detection people will also have more resources available and be able to seek treatment long before it becomes a serious medical problem, thus reducing the cost, not only in treatment but loss of lives. 

 HIV disease is a disease of poverty. In the United States, HIV infection disproportionately affects uninsured, low-income persons [10, 11], who constitute a vulnerable population that often has multiple health care needs.  While this statement does have a bases for fact it also fails to mention that uninsured, low income people make up a significant part of the US population.  Broad statements such as HIV disease is a disease of poverty.  can only further add to the stigma and stereo typing of HIV, thus giving the affluent and wealthy the validation that because of the wealth and social status they are  impervious to the HIV virus.  For this reason many seem to think that they are beyond getting HIV and until a serious health problem strikes them they will go untested.  We all know that HIV could care less about ones wealth or the origin of their parents.  So long as people continue to think of HIV as a poor man disease it will continue to spread unchecked in the other social groups.

Anne I understand your dismay at discussing sex with your doctor.  This should not be a taboo subject or “uncomfortable” 

Although patients are more likely to test when their physicians suggest it many physicians do not do so because pretest counseling takes considerable time and discussing sexual and drug behaviors that risk transmission may be uncomfortable.

Again I think the “uncomfortable” refers to the pretest counseling and linking a patients sexual or drug habits to the risk of transmission of HIV.  Again we are back to the stigma and stereo typing that HIV is a disease of the poor, indigent or social out cast.  Making the HIV test as routine as any other blood work can only help to diminish these stigmas and stereo types.  Counseling should be done upon the request of the patient  i.e. asking if they have any question and answering them should suffice.  On the same token post test counseling should be done only on an as needed or requested basis.  Most people are better informed about HIV than they let on, as my ID doctor told me today as we were discussing this very subject.  Of course referrals to ID clinics and HIV resources should be readily available and freely accessible.
Mikey

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #106 on: October 19, 2007, 01:06:09 PM »
Making the HIV test as routine as any other blood work can only help to diminish these stigmas and stereo types.  Counseling should be done upon the request of the patient  i.e. asking if they have any question and answering them should suffice.  On the same token post test counseling should be done only on an as needed or requested basis.  Most people are better informed about HIV than they let on, as my ID doctor told me today as we were discussing this very subject.

Mike,

I think you are not being realistic and in fact are ignoring points repeatedly brought up to you and others with this rationale.  Do you really equate being diagnosed with HIV as routine as being told you have high cholesterol?  I know that is not what you said exactly, but checking someone for cholesterol is an example of a routine blood test.  Does my example not show you the danger in minimizing this test into that category?

After all, Mike, if this was just a routine virus with no long term physical, mental and sociological effects on those with it, how do you explain your own need to participate in these forums or your own myspace profile which needs to make HIV the centerpiece of your profile or the very group you yourself started for yourself and others with HIV?

Now I would surmise that you would suggest that all the above exist for you and others to deal with HIV, to educate and to counter existing stigma by bringing it into the light or bringing it into the open - and I would applaud you, but I would also have to tell you that the very act of needing to bring it into the light or open is contrary to the arguments you have made so far.

Frankly I am amazed you made your last post after this thread was already out:  http://forums.poz.com/index.php?topic=16404.0 These are people who have gotten their results yet years later are suffering from stigma.   I know your argument, but I would like to see some backing for your argument such as some studies showing people who have been tested without counseling and who feel they didn't need to discuss and deal with it and are not suffering any stigma. 

Now your idea that counseling is provided for those who ask for it is frankly unbelievable logic at best, and denies the reality that upon receiving their diagnosis most people can attest to being in anger, denial, shock, despair, but rarely calm indifference and able to make the most rationale conclusions.  In my mind it is like asking who was injured in a car crash if they really need medical care.

And as far as what you and your doctor talked about - Yes, I agree that most of us who have the virus and deal with it everyday can at times be flabbergasted that people don't yet have a clue, but may I suggest you spend some time in the Am I Infected? forum before you come to such a steadfast view of others knowledge of HIV?   Now, If you don't want to accept anecdotal evidence, then try the Terrance Higgins Trust study issued this summer which had one amazing finding: "Almost a quarter of them (18-24 year olds) believe that condoms have holes in them which let HIV through. "  http://www.tht.org.uk/mediacentre/pressreleases/2007/july/july4.htm And keep in mind that the UK is much more ahead of the U.S. when it comes to sex education and discussing condoms in the classroom.

Finally, if all that is not enough, why don't you take a look at the WHO/UNAIDS March 2007 report on Testing guidelines which stipulates the following on their testing guidelines:

 
Quote
Other key WHO/UNAIDS recommendations for provider-initiated HIV testing and counselling in health facilities include:

    * Pre-test information and post-test counselling remain integral components of the HIV testing process.

    * Patients should receive support to avoid potential negative consequences of knowing and disclosing their HIV status, such as discrimination or violence.

    * Testing must be linked to appropriate HIV prevention, treatment, care and support services.
  http://www.who.int/mediacentre/news/releases/2007/pr24/en/index.html

You may disagree with all that is said here Mike, but I do wish you would respond with some studies or concrete rationale to back up your arguments cause frankly I feel that you have been simply talking around what people here have posted vs. actually responding to the direct points.  While I respect your opinion, I think it's time for you to show what actually got you to form that opinion vs. just to keep repeating it.

« Last Edit: October 19, 2007, 01:12:35 PM by Iggy »

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #107 on: October 19, 2007, 06:16:03 PM »
I would like to directly address some statements by Iggy;
  I know your argument, but I would like to see some backing for your argument such as some studies showing people who have been tested without counseling and who feel they didn't need to discuss and deal with it and are not suffering any stigma.
I don’t know where this came from, but it did not come from my last post.   At least I don’t see it in the 656 words of my last post.  I did not say that people who do not receive pre or post test counseling do not suffer stigma.  Thus I have NO need to provide proof of something I did not say.  I have not said or suggested that counseling should be done away with, what I did say is,  Counseling should be done upon the request of the patient  i.e. asking if they have any question and answering them should suffice.  On the same token post test counseling should be done only on an as needed or requested basis.  Clearly what I have said, and what you suggest I was saying are as different as night and day.

Now your idea that counseling is provided for those who ask for it is frankly unbelievable logic at best, and denies the reality that upon receiving their diagnosis most people can attest to being in anger, denial, shock, despair, but rarely calm indifference and able to make the most rationale conclusions.  In my mind it is like asking who was injured in a car crash if they really need medical care.  This summarization shocks me.  Anyone who is injured in a car accident has every legal right to refuse medical care.  Unless they unconscious or are not lucid any one can refuse treatment.  Just because one may be in shock, denial, despair or angry does not preclude them from making rational conclusions as to their own personal needs or desires for medical care.

After all, Mike, if this was just a routine virus with no long term physical, mental and sociological effects on those with it, how do you explain your own need to participate in these forums or your own myspace profile which needs to make HIV the centerpiece of your profile or the very group you yourself started for yourself and others with HIV?  First off I have never said that HIV was a routine virus with no long term effects.  However seeing that you have brought this up perhaps it’s time that I do mention that an HIV+ test result is no longer the death sentence it once was 20 years ago.   People can live full lives with HIV  This is not an opinion it is a medical fact.  Those who continue to treat HIV and act as if it is a death sentence are contributing to the stigma.  This not to say HIV is not serious but it’s prognosis is far more hopeful than it has been in the past. 

Lastly
Do you really equate being diagnosed with HIV as routine as being told you have high cholesterol?  I know that is not what you said exactly, but checking someone for cholesterol is an example of a routine blood test.   Your right that is NOT exactly what I said.  However, so many seem to like to use that example I find it only fitting to point out that, “Your blood cholesterol level has a lot to do with your chances of getting heart disease. High blood cholesterol is one of the major risk factors for heart disease. A risk factor is a condition that increases your chance of getting a disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease.
http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm#risk
  Surely you can not deny that a heart attack or death is not a life altering condition.   Just for the record I have never equated getting a positive HIV test result with finding out you have high cholesterol.  However lets not diminish the seriousness of having high cholesterol.
 I see the CDC’s recommendation to make HIV testing “routine” as a way to make testing easier for doctors and for patients.  Through this there will in fact be more cases of HIV diagnosed.  When a truer number of HIV cases can be identified there will be a stronger urgency for more research into finding better ways of treating it and even finding a cure.  How can this translate to a bad thing.  In the process many people will find out that they have HIV who would not have know until they became very ill.  They can seek treatment sooner and live longer lives. They will also know their status and be better able to protect themselves and others.  Again I ask how can this translate to a bad thing.
Mikey

Offline David_CA

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #108 on: October 19, 2007, 06:52:05 PM »
Pre- and post-HIV counseling have their places.  We obviously know of the benefits of counseling when an individual tests positive.  How about when they test negative?  Isn't that a good time to discuss how to stay negative, to explain the basics of HIV transmission, and to discuss the consequences of testing positive in the future?  The cholesterol argument isn't really comparable.  "Your cholesterol is fine.  Now, do you know how to keep it low?  Do you know how high cholesterol can cause problems?"  That's silly, unless one has had issues with it in the past.  As to negative HIV test counseling - "Your HIV test came back negative.  That's good.  Now, the important thing is to keep you negative.  Do you know the basics of HIV transmission?  ...."  It all seems really basic to me.

David

Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
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10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
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05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
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Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #109 on: October 20, 2007, 10:06:58 AM »
Hi David
I would agree that these are good times to discuss these issues.  As the current mandate goes these are things that “MUST“  be discussed pre and, or post testing.
  At this point I would like to point out just a few things about the recommendations that may have been misread.
Now the recommendation state the following;
"These revised recommendations update previous recommendations for human immunodeficiency virus (HIV) testing in health-care settings and for screening of pregnant women (see "Guideline Status" field). Major revisions from previously published guidelines are as follows:
For patients in all health-care settings
•   HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
•   Persons at high risk for HIV infection should be screened for HIV at least annually.
•   Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
•   Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings."

Granted this is just the very first part of the recommendations none the less they are very important points.  These recommendations would and do allow for HIV to be treated more like any other STD as far as testing goes.  "Prevention counseling should not be Required..."  should not be Required, being the key words.  The same goes for special consent forms.   The phrase “should not be required” dose NOT mean “Shall be eliminated”  As these “special consent forms” and “counseling” are directly linked to funding at this time, recommendations such as this will help to open the door to more people being tested without clinics and other medical settings loosing their funding.  It also leaves the door open to counseling for those who need or want it.  I personally would hope that any Doctor would discuss what the tests results mean to a person be it an HIV test or any other test.
Mikey

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #110 on: October 20, 2007, 10:23:17 AM »
Mike,

I feel you and I will go in circles and I don't think that helps the issue.

I accept that we see this issue differently and feel comfortable that in my discussion with you that my previous posts repeatedly and clearly outlines the errors in your thoughts and logic on the issue, while clearly supporting my point with clear and basic logic and  backing from studies and points stated by recognized leaders in the fight against HIV and world health organizations. - Frankly I don't think one can get clearer that the World Health Organization and the UNAIDS saying that pretest and post testing counseling must go hand in hand with testing...

I hope someday that you can grow in your understanding of the issue to appreciate what I have said in regards to this issue.

Pre- and post-HIV counseling have their places.  We obviously know of the benefits of counseling when an individual tests positive.  How about when they test negative?  Isn't that a good time to discuss how to stay negative, to explain the basics of HIV transmission, and to discuss the consequences of testing positive in the future?  The cholesterol argument isn't really comparable.  "Your cholesterol is fine.  Now, do you know how to keep it low?  Do you know how high cholesterol can cause problems?"  That's silly, unless one has had issues with it in the past.  As to negative HIV test counseling - "Your HIV test came back negative.  That's good.  Now, the important thing is to keep you negative.  Do you know the basics of HIV transmission?  ...."  It all seems really basic to me.

David



David - Thank you. 

You reiterated what I have said in my previous posts very well and that which is continuously seems to be lost by those who do not understand the counseling as a necessary requirement to go hand in hand with testing. 
Quote
I'm certain you must realize that someone getting a diagnosis of being neg today is not conclusive of whether of not they are neg at the time of the test results and has nothing to do with their status at the time of the test results if they engaged in any risky behaviour since testing.

It's not if people will or won't use condoms because of a test result saying they have HIV, it is if people understand what a test result does mean and doesn't mean whether it says they are HIV positive or negative and then acting erroneously because of lack of education and counseling....

Quote
We continue to see on this board how many people become embolden to continue having unsafe sex simply because they got a neg result...and yet as we all know a neg result doesn't necessarily mean one is neg, now does it?

So to your statement that State Laws are contributing to the Spread of AIDS because of counseling requirements - I ask:

Would you not agree that implicit in telling people that they have a neg result is counseling them and educating them on what the result means and what it doesn't mean and how to avoid risking themselves or others? 

I truly find it very disheartening that anyone would feel the need to make an argument against tying education and counseling to testing.  Thank you for getting it.

Offline next2u

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #111 on: October 22, 2007, 01:37:16 AM »
aiight, im gonna have to side with wes on this one. this thread is damn long, but it's a good fucking read. that pre/post counseling notion is crap. for me it was a signature on a piece of paper and a phone call from my apologetic doctor two weeks later. is counseling good, yes, does it matter - sure. but just reading that form is different from knowledge and experience. just cause someone reads something on a form doesn't mean they will understand it, especially if they have no relative experience to the subject. on my consent form there was a statement about discrimination and how a positive result could compromise the quality of life... that's all true, but it doesn't change my fucking status and it sure not gonna help someone who can't relate.

having routine testing and reducing hurdles to these tests is a great idea. preparing someone for how individuals and society is going to react, that's a rather daunting task and i don't feel it should be shouldered entirely by the heathcare community. media, government, educational institutions, and other civil infrastructures should pitch in. reading about discrimination and tackling it are two different tasks, and i don't think a consent form or the 15 minute slot given by any hmo adequately addresses the issue - so fuck it, test them and lets work on the problem comprehensively. testing and knowing is more important. emotional/mental damage will happen sometimes, but getting into a program, whether underfunded or a bureaucratic nightmare, is more important. and if the program isn't there, the person who is poz is now in an informed position and can begin looking for other options.

yes, funds are dwindling and healthcare may be out of reach for some, but knowing ones status is crucial to the preservation of self. if i hadn't requested the test i never would have found out. hiv testing is not routine at my doc's. even though i am in a high risk group my docs never suggested that i test. when i seroconverted i saw two different doctors who both misdiagnosed me. i had to request the test myself, and yes, they knew i was sexually active. now my numbers appear low and lord only knows how much worse things would be if i hadn't found out. then it took over a fucking month just to get an appt with an id doc after my diagnosis.

if someone is gonna go off the deep end, a pre/post consent or counseling form is hardly gonna stop them. a loving family, decent education, access to resources, great peeps like here in our poz community, and hope will produce comparable or better results than a consent or counseling form.

information is needed for change. that information can only be obtained from a test. hopefully the numbers will encourage greater distribution of knowledge & supplies (condoms, needles). okay, im sorry for being an ass, but i think the counseling should happen presex, not pre/post test, but we all know this isn't a perfect world. and yes, i spent an inordinate amount of time on the counseling/consent forms. they just peeved the hell out of me.   
midapr07 - seroconversion
sept07 - tested poz
oct07 cd4 1013; vl 13,900; cd4% 41
feb08 cd4  694;  vl 16,160; cd4% 50.1
may08 cd4 546; vl 91,480; cd4% 32
aug08 cd4 576; vl 48,190; cd4% 40.7
dec08 cd4 559; vl 63,020; cd4% 29.4
feb09 cd4 464; vl 11,000; cd4% 26
may09 cd4 544; vl 29,710; cd4% 27.2
oct09 cd4 ...; vl 23,350; cd4% 31.6
mar10 cd4 408; vl 59,050; cd4% 31.4
aug10 cd4 328; vl 80,000; cd4% 19.3 STARTED ATRIPLA
oct10 cd4 423; vl 410 ;); cd4% 30.2
jun11 cd4 439; vl <20 ;); cd4% 33.8 <-Undetectable!
mar12 cd4 695; vl ud; cd4% 38.6
jan13 cd4 738; vl ud; cd4% 36.8
aug13 cd4 930; vl ud; cd4% 44.3
jan14 cd4 813; vl ud; cd4% 42.8
may14 cd4 783; vl *; cd4%43.5

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #112 on: October 22, 2007, 10:07:15 AM »
aiight, im gonna have to side with wes on this one. this thread is damn long, but it's a good fucking read. that pre/post counseling notion is crap.

Amazing summary rejection of what people in the field, educators, activists, studies and what is witnessed in the AM I infected forum everyday have repeatedly demonstrated. 

Unfortunately I think you (and many) completely miss a vital point in this debate that makes your pronouncements a little premature, and very foolish.

The error in your argument lies in your take on the situation based on your individual experience - in other words: your subjective view on what it means to YOU.  You make pronouncements of the good and the bad, vital and useless, important and unnecessary, solely on the effect it has with you and on your own knowledge of life.  Unfortunately in order to actually understand problems and solutions in the matter of curbing the spread of HIV infections for everyone, you need to broaden your point of view to understand that not everyone is you, and you should not be dictating what is or isn't required for the masses whether or not you think it is something worthy of your personal time. 

In other words, when you say things like this:
Quote
If someone is gonna go off the deep end, a pre/post consent or counseling form is hardly gonna stop them. a loving family, decent education, access to resources, great peeps like here in our poz community, and hope will produce comparable or better results than a consent or counseling form.

I need to ask you why you would reach with the assumptions that everyone has a good family, decent education, have the ability to have a positive outlook, access to resources or even know people in the community as being a viable alternative to making sure that at the time of the test that every individual has mandated direct access to a counselor who can in fact provide them the connection to support groups and realistic, practical and factual information about their diagnosis?

Also the moral judgments of the value of family, education and optimistic (perhaps spiritual?) outlook is a deterrent to helping and reaching anyone who doesn't fall neatly into such pigeonholed categories.  Perhaps you do not even recognize this, but your above argument that I highlighted is not far at all from those who would deny funding for condoms, distribution of clean needles, and sex education in the classroom simply because they feel that HIV prevention is a matter of morality and personal choice and not simply a virus and something that requires government involvement.

Frankly I just don't understand the rationale that because it doesn't seem necessary to one that they have the right to deny it being provided to others.

One last thought to consider in your argument and something I've yet to see addressed by any who would do away with counselling requirements:  Many of you are making your argument that a key way to combat HIV and stop the spread of new infections boils down to an issue of providing all people with important and vital information:  The information of their HIV status.  A good and rationale idea, and I might add, one that I agree with.  However ask yourself how one can honestly make a such an argument by stating that we must only focus on the selective information (the test result) at the cost of complete information (what that test result actually means and how to avoid infection - whether infected yourself or another)? 

I personally don't see it as possible nor logical -  at least not without hypocrisy.



Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #114 on: October 22, 2007, 10:23:45 AM »
Knowledge is power.

http://www.washingtonpost.com/wp-dyn/content/article/2007/10/21/AR2007102101368.html

From the article:
Holbrooke is also correct to emphasize the importance of HIV testing, especially for providing the main gateway into treatment. There is, however, little evidence that knowing one's HIV status fundamentally alters behavior. A few studies have found some modest changes in behavior among those who test positive, but most trials unfortunately show that people who discover that they are not infected with the virus continue acting as they did before being tested -- despite the obvious danger to themselves and to others.


Thank you Hal!
« Last Edit: October 22, 2007, 10:38:23 AM by Iggy »

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #115 on: October 22, 2007, 11:05:31 AM »
•Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings."[/color]

Don't you think someone who tests negative needs to be told that if they have engaged in unsafe sex during the past 3 months that they could have become infected and it not show on the their HIV+.  Therefore this happens:

There is, however, little evidence that knowing one's HIV status fundamentally alters behavior. A few studies have found some modest changes in behavior among those who test positive, but most trials unfortunately show that people who discover that they are not infected with the virus continue acting as they did before being tested -- despite the obvious danger to themselves and to others.

I personally would hope that any Doctor would discuss what the tests results mean to a person be it an HIV test or any other test.

And I would hope that Bush would realize his mistake and get us out of Iraq.  Doctors of large practices hire consultants to tell them the best way to make money. They need to see x number of patients in x amount of time, meaning they need to spend 6 minutes per patient.  Not much time for counseling.  When I told my doctor I wanted to take the HIV test as part of my routine physical he said fine and checked it on the form.  I was notified 2 weeks later on the phone at work.  He told me I was poz, it wasn't as bad as it used to be and that his office would make a referral.  That was it.

.... if the program isn't there, the person who is poz is now in an informed position and can begin looking for other options.....
.... a loving family, decent education, access to resources, great peeps like here in our poz community, and hope will produce comparable or better results than a consent or counseling form.

I am not sure what to make of these two statements, they just smack of someone who has all of these things and is completely unaware of the problems those who don't have them encounter. 
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline next2u

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #116 on: October 22, 2007, 10:36:06 PM »
I don’t expect anyone to read all this gibberish, but here it goes.

Look igg-meister,

You are one hell of a thinker and raise a shitload of great points. With that said, your points fail to miss a crucial aspect my post, that we cannot lay the entire responsibility of support/understanding/counseling on medical institutions. These changes need to be cradled by multiple facets of our society.

My personal hmo experience has been echoed by others – shitty hmo’s. a signed consent form, an impatient doctor, an overbooked nurse – where’s the rarity in this situation? It happens all the time. Yes, it would be fucking wonderful if a dr and psychiatrist sat down, held our hands, on told us the world would be different. Unfortunately docs don’t have that much time, and lengthy therapy sessions in a hospital aren’t viable.

My assessments about knowledge being crucial has two aspects. one – the person receiving the information may not be able to process it, regardless of the form it is in. also, having an understanding of something is far different from experiencing it. Secondly, to have the information of one’s status lets a person actively decide to deny or accept it. Hey, im not saying this will work for everyone, but I do believe the majority of informed people will take necessary steps to preserve self, it’s some type of biological imperative.

As for my assumptions (and yes, I am answering you point for point, you have the mental wheels cranking) – I did not assume we all had this wonderful resource pool. I was trying to show that other factors can have influence on a newly diagnosed person. In the case of anonymous testing, or my hmo, pozzies receive phone calls or quickies. For patients whose dr’s make them come in great – but the newly diagnosed have to leave that doctor and that is when the other support is necessary. If someone does not have access to these resources, hopefully they can begin a search for some. As I said earlier, it is still better to know because the person can begin looking for ways to take care of themselves. Be it at a library, through a friend, a gay center, the internet, an aids hotline, or a drastic move, a determined soul can find a means to survive. And I did not say this would be easy – just more pertinent if a person knows their status.

Do I think counseling forms are pointless, no, but in many cases they are ineffective. Reading about the possibilities and experiencing them are vastly different.  I just don’t understand how a written statement about discrimination is gonna help someone. Or how a brief sentence on depression is gonna make a difference. If these things were more comprehensive that’d be great. But they are not- and it’s almost fucking laughable. we know from the stigmas in society how people will  react. disease brings shame, creates pariahs, makes us whores. that shit ain't on a fucking counseling form, its part of the cultural inculcations that have been happening since birth. since these thoughts are not supported by the hospital, i don't feel it's the hospitals sole responsibility to address them.

And exactly why I am being faulted for mentioning a comprehensive solution as superior to a brief document? Family, friends, networking, etc… are great fucking support. My counseling document didn’t say things will be shitty, but with meds and support you can get through this. The people here told me that. My support group told me that. My friends, literature, etc helped me through this. My doc though my insurance company? He told me I might have 10 years to live. Great fucking document, great fucking doctor. And yes, I do (did) pay him for his advice. 

And no where in my entire response did I advocate removing counseling. I simply believe consent forms/counseling forms are not the best way of helping someone transition or prepare for the new life they will be facing. Especially not in the settings ive read or heard about. I remember signing those shiznits at the co dept of health, there wasn’t a soul there to talk to. The form was even shorter and the staff was antagonistic. Where the fuck do I get off sounding like an optimist?

Uggh, this is gonna go on forever and I don’t wanna burden the thread with this longass circuitous response. Man, I went off on an aspect of the problem. Revealing someone’s status is important, but prevention information is exceptionally important also, hence the presex conversation line. And if someone is positive, hopefully they will do what they can to prevent infection. Like, you can take a horse to water but you can’t make her drink.

Lastly, mr woodshere (im loving your profile pic), yes, I do have some of those things. My dad passed away last year (ive seen him two times since I was 14), my stepdad calls every 6 months, me and my mom fight every time we talk, I have access to resources cause my credit debt is astronomical, but I get the best support here. Anyone can access this forum. Now, let’s not get into a debate about the digital divide, class or status. I am not saying everyone has access to the same resources, I am saying that knowing ones status will increase the desire to access these resources in order to preserve self.

And for you iggy, they didn’t even let me take the fucking counseling form home. yes, I am being subjective, but everyone is subjective and the only people who don’t believe so are fucking lying to themselves. We understand the world from our personal experiences and grapple with life based on our paradigms. You can produce stats that can support your arguments and so can I, so what makes your stance more legitimate? I like talking in first person and being subjective. As far as im concerned distancing myself from this argument is a luxury I can’t afford.   
midapr07 - seroconversion
sept07 - tested poz
oct07 cd4 1013; vl 13,900; cd4% 41
feb08 cd4  694;  vl 16,160; cd4% 50.1
may08 cd4 546; vl 91,480; cd4% 32
aug08 cd4 576; vl 48,190; cd4% 40.7
dec08 cd4 559; vl 63,020; cd4% 29.4
feb09 cd4 464; vl 11,000; cd4% 26
may09 cd4 544; vl 29,710; cd4% 27.2
oct09 cd4 ...; vl 23,350; cd4% 31.6
mar10 cd4 408; vl 59,050; cd4% 31.4
aug10 cd4 328; vl 80,000; cd4% 19.3 STARTED ATRIPLA
oct10 cd4 423; vl 410 ;); cd4% 30.2
jun11 cd4 439; vl <20 ;); cd4% 33.8 <-Undetectable!
mar12 cd4 695; vl ud; cd4% 38.6
jan13 cd4 738; vl ud; cd4% 36.8
aug13 cd4 930; vl ud; cd4% 44.3
jan14 cd4 813; vl ud; cd4% 42.8
may14 cd4 783; vl *; cd4%43.5

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #117 on: October 23, 2007, 08:55:21 AM »
Thanks Next,

I'll try my best here:
And no where in my entire response did I advocate removing counseling. I simply believe consent forms/counseling forms are not the best way of helping someone transition or prepare for the new life they will be facing.
You did right here: 
aiight, im gonna have to side with wes on this one. this thread is damn long, but it's a good fucking read. that pre/post counseling notion is crap.
Besides saying you agree with Wes - who is advocating the removal of counseling requirements as he sees it as the barrier to mass testing... you point blank said that pre/post testing is crap.

If you meant something different then so be it - but what you said in the post and I responded to was clear.

Quote
And exactly why I am being faulted for mentioning a comprehensive solution as superior to a brief document?
Because you seem to still not recognize that what is deemed superior by you is not superior (or even available for) to everyone.
 
  • Not everyone has a great family - in fact there are many here who can tell of being abandoned by family. 
  • Your point about a decent education is not logical - did a decent education keep anyone from contracting the virus to begin with? 
  • The hopeful outlook that you suggest is a little laughable when you consider that a person who is getting a diagnosis of being HIV infected rarely has a first thought of looking for a silver lining.
  • And suggesting that the people in the community are a better alternative to information than a doctor's office is partially true, though wonder if you think that people just automatically know where to find them....and keep in mind not everyone is an internet master or lives in a urban community.

That is why I fault this line of thinking of you here - not because you find strength in such items (actually I applaud you for that) but you trying to make a case that because it works for you then that is reason to assume it will work for anyone else...and that is exactly what you are doing when you suggest it as a viable alternative to universal access to a counseling at the time of testing.

Now I do agree with you that counseling as just a form to be read and signed doesn't cut it - I agree 100% But I don't think the solution is in just saying we abandon counseling. If that was the case than we might as well abandon any outreach.

As far as you stating doctors and nurses are overworked to begin with and should not be burdened with counseling  - I partially agree.  I disagree that  to discuss the medical facts of a virus and what it means to the infected person is outside the scope of their job...on the contrary - that is in fact the very point of their job - however I do feel that most of the doctors and nurses today are in fact burdened with paperwork that keeps them from having the time to actually do that job. If you wanted to write a diatribe about the insurance industry (who might I add is a party with deep pockets who are one of the lobbying parties trying to fight the counseling requirements) then I am right there with you, but I don't consider counseling with test results a burden to the medical community. 

What I think is funny (in a very sad way) is how many people don't realize that when they rail against the counseling requirements by citing paperwork  burdens to the medical community they do not realize they are in fact just promoting a pr line put out by the insurance community who certainly has no issues with a doctor's paperwork burden -  as long as it is in regards to processing payments, of course.

I think a problem here is that you and many misunderstand the notion of counseling in the context of testing because of the bastardization of the meaning of the word by American self help movement.   Counseling is not hand holding, feel good sessions or tributes to teary eyed moments of a Lifetime movie.  Counseling in relation to testing (or general medical situations) is the providing of facts and resources in understanding and dealing with the medical situation - something that is intricate to the medical professionals job. 

I fail to comprehend why that is an issue for anyone to debate. 
 

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #118 on: October 23, 2007, 09:20:34 AM »
Lastly, mr woodshere (im loving your profile pic), yes, I do have some of those things. My dad passed away last year (ive seen him two times since I was 14), my stepdad calls every 6 months, me and my mom fight every time we talk, I have access to resources cause my credit debt is astronomical, but I get the best support here.


Next2u, I must apologize, I made a sweeping uninformed judgement, that was out of order.  

A statement such as this:

Anyone can access this forum. Now, let’s not get into a debate about the digital divide, class or status. I am not saying everyone has access to the same resources, I am saying that knowing ones status will increase the desire to access these resources in order to preserve self.
 is just as sweeping and uninformed as mine.  When discussing HIV or for that matter any medical situation you cannot just disregard class or status.  They play a vital role.  You are correct that anyone regardless of class or status can walk into a public library and gain access to a computer provided they have a library card.  Of course when you are homeless you don't have a permanent address to list which might prohibit you getting a card.  But for discussion sake let's say this homeless person gets access to a computer.  It is difficult to use a computer if you dropped out of school 30 years ago and have never even used one.  But fortunately instructions are available, too bad you read at the first grade level if at all.  Someone who is living in poverty, most likely has very little education and is on the bottom rung of the "status ladder"  faces obstacles that you and I can handle but for them they get lost.  And when one is lost the desire to preserve self is likely to be lost also.

Now don't get me wrong knowing ones status is very important.  But if these basic problems are not addressed the spread of HIV and Aids will not slow thanks just to routine testing.
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline next2u

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #119 on: October 24, 2007, 01:05:51 AM »
woodshere - iggy, you two are great :)

this will be taken up again at a later time (i have a lot excuses). wow, you two won't let me out easy on this one. iggy, good definition on counseling. stop negating my points, you are making it hard for me to keep up. woodshere, my statement was too sweeping - damn it. hmm, i guess its not worth debating if you all don't put up a good resistance. but without the debate their is no growth. while i still don't agree with you 100%, i have changed my viewpoint.

and iggy's pic is adorable too : )

but seriously, state laws are fucking us. to be continued...
midapr07 - seroconversion
sept07 - tested poz
oct07 cd4 1013; vl 13,900; cd4% 41
feb08 cd4  694;  vl 16,160; cd4% 50.1
may08 cd4 546; vl 91,480; cd4% 32
aug08 cd4 576; vl 48,190; cd4% 40.7
dec08 cd4 559; vl 63,020; cd4% 29.4
feb09 cd4 464; vl 11,000; cd4% 26
may09 cd4 544; vl 29,710; cd4% 27.2
oct09 cd4 ...; vl 23,350; cd4% 31.6
mar10 cd4 408; vl 59,050; cd4% 31.4
aug10 cd4 328; vl 80,000; cd4% 19.3 STARTED ATRIPLA
oct10 cd4 423; vl 410 ;); cd4% 30.2
jun11 cd4 439; vl <20 ;); cd4% 33.8 <-Undetectable!
mar12 cd4 695; vl ud; cd4% 38.6
jan13 cd4 738; vl ud; cd4% 36.8
aug13 cd4 930; vl ud; cd4% 44.3
jan14 cd4 813; vl ud; cd4% 42.8
may14 cd4 783; vl *; cd4%43.5

Offline mecch

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #120 on: October 01, 2008, 04:40:46 PM »
I strongly disagree. ....  IF the government agreed to guarantee treatment to people with HIV, then I think streamlined testing makes sense.  But in the present climate of private healthcare, where insurers are desperate to find ways to exclude people from coverage, I worry that HIV tests without consent would contribute to discrimination against people with HIV. 

I am in Koksi's camp on this one.  Mandatory HIV testing - great for controlling the epidemic -- still only makes sense in a country that commits to universal health care.  See K. Marx's mandate, below....
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline hivsweden

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #121 on: October 01, 2008, 05:28:46 PM »
[Removed] Did not notice thread was old until Sharkdiver pointed it out.
« Last Edit: October 01, 2008, 06:21:07 PM by hivsweden »

Offline sharkdiver

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #122 on: October 01, 2008, 06:11:37 PM »
This thread is almost a year old.  And, some members who posted on it and started it are no longer part of this forum . If you think it is an important topic, it would probably be a good idea to start a new one.

Offline sharkdiver

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #123 on: October 02, 2008, 12:12:31 AM »
Figaro,

I understand your passion behind the needle exchange, but you aren't POZ. 

 


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